Thermal oxidation of nuclear graphite: A large scale waste treatment option

Science.gov (United States)

Jones, Abbie N.; Marsden, Barry J.

2017-01-01

This study has investigated the laboratory scale thermal oxidation of nuclear graphite, as a proof-of-concept for the treatment and decommissioning of reactor cores on a larger industrial scale. If showed to be effective, this technology could have promising international significance with a considerable impact on the nuclear waste management problem currently facing many countries worldwide. The use of thermal treatment of such graphite waste is seen as advantageous since it will decouple the need for an operational Geological Disposal Facility (GDF). Particulate samples of Magnox Reactor Pile Grade-A (PGA) graphite, were oxidised in both air and 60% O2, over the temperature range 400–1200°C. Oxidation rates were found to increase with temperature, with a particular rise between 700–800°C, suggesting a change in oxidation mechanism. A second increase in oxidation rate was observed between 1000–1200°C and was found to correspond to a large increase in the CO/CO2 ratio, as confirmed through gas analysis. Increasing the oxidant flow rate gave a linear increase in oxidation rate, up to a certain point, and maximum rates of 23.3 and 69.6 mg / min for air and 60% O2 respectively were achieved at a flow of 250 ml / min and temperature of 1000°C. These promising results show that large-scale thermal treatment could be a potential option for the decommissioning of graphite cores, although the design of the plant would need careful consideration in order to achieve optimum efficiency and throughput. PMID:28793326

Thermal oxidation of nuclear graphite: A large scale waste treatment option.

Directory of Open Access Journals (Sweden)

Alex Theodosiou

Full Text Available This study has investigated the laboratory scale thermal oxidation of nuclear graphite, as a proof-of-concept for the treatment and decommissioning of reactor cores on a larger industrial scale. If showed to be effective, this technology could have promising international significance with a considerable impact on the nuclear waste management problem currently facing many countries worldwide. The use of thermal treatment of such graphite waste is seen as advantageous since it will decouple the need for an operational Geological Disposal Facility (GDF. Particulate samples of Magnox Reactor Pile Grade-A (PGA graphite, were oxidised in both air and 60% O2, over the temperature range 400-1200°C. Oxidation rates were found to increase with temperature, with a particular rise between 700-800°C, suggesting a change in oxidation mechanism. A second increase in oxidation rate was observed between 1000-1200°C and was found to correspond to a large increase in the CO/CO2 ratio, as confirmed through gas analysis. Increasing the oxidant flow rate gave a linear increase in oxidation rate, up to a certain point, and maximum rates of 23.3 and 69.6 mg / min for air and 60% O2 respectively were achieved at a flow of 250 ml / min and temperature of 1000°C. These promising results show that large-scale thermal treatment could be a potential option for the decommissioning of graphite cores, although the design of the plant would need careful consideration in order to achieve optimum efficiency and throughput.

Treatment Effects

DEFF Research Database (Denmark)

Heckman, James J.; Lopes, Hedibert F.; Piatek, Rémi

2014-01-01

This paper contributes to the emerging Bayesian literature on treatment effects. It derives treatment parameters in the framework of a potential outcomes model with a treatment choice equation, where the correlation between the unobservable components of the model is driven by a low-dimensional v......This paper contributes to the emerging Bayesian literature on treatment effects. It derives treatment parameters in the framework of a potential outcomes model with a treatment choice equation, where the correlation between the unobservable components of the model is driven by a low...... to observe the same person in both the treated and untreated states, but it also turns out to be straightforward to implement. Formulae are provided to compute mean treatment effects as well as their distributional versions. A Monte Carlo simulation study is carried out to illustrate how the methodology can...

Evaluation of the clinical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores.

Science.gov (United States)

Cho, Soo Ick; Chung, Bo Young; Choi, Min Gyu; Baek, Ji Hwoon; Cho, Hee Jin; Park, Chun Wook; Lee, Cheol Heon; Kim, Hye One

2012-07-01

Fractional technology overcomes the problems of ablative lasers, such as inaccurate depth control and damage to the epidermis. Minimally invasive fractional radiofrequency microneedle devices allow for more-selective heating of the dermis. To evaluate the clinical efficacy of fractional radiofrequency microneedle (ERM) treatment in acne scars and large facial pores. Thirty patients with acne scars and large facial pores were enrolled. Bipolar radiofrequency energy was delivered to the skin through the electrodes of the FRM device. Skin lesions were evaluated according to grade of acne scars, Investigator Global Assessment of large pores, skin surface roughness, transepidermal water loss (TEWL), dermal density, microscopic and composite image, sebum measurement, and questionnaires regarding patient satisfaction. The grade of acne scars and Investigator Global Assessment of large pores improved in more than 70% of all patients. Skin surface roughness, dermal density, and microscopic and composite images also improved, whereas TEWL and sebum measurement did not change. Clinical improvement from FRM treatment appeared to be related to dermal matrix regeneration. FRM treatment may be effective in improving acne scars and facial pores. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Effect of high temperature heat treatments on the quality factor of a large-grain superconducting radio-frequency niobium cavity

Science.gov (United States)

Dhakal, P.; Ciovati, G.; Myneni, G. R.; Gray, K. E.; Groll, N.; Maheshwari, P.; McRae, D. M.; Pike, R.; Proslier, T.; Stevie, F.; Walsh, R. P.; Yang, Q.; Zasadzinzki, J.

2013-04-01

Large-grain Nb has become a viable alternative to fine-grain Nb for the fabrication of superconducting radio-frequency cavities. In this contribution we report the results from a heat treatment study of a large-grain 1.5 GHz single-cell cavity made of “medium purity” Nb. The baseline surface preparation prior to heat treatment consisted of standard buffered chemical polishing. The heat treatment in the range 800-1400°C was done in a newly designed vacuum induction furnace. Q0 values of the order of 2×1010 at 2.0 K and peak surface magnetic field (Bp) of 90 mT were achieved reproducibly. A Q0 value of (5±1)×1010 at 2.0 K and Bp=90mT was obtained after heat treatment at 1400°C. This is the highest value ever reported at this temperature, frequency, and field. Samples heat treated with the cavity at 1400°C were analyzed by secondary ion mass spectrometry, x-ray photoelectron spectroscopy, energy dispersive x ray, point-contact tunneling, and x-ray diffraction, and revealed a complex surface composition which includes titanium oxide, increased carbon, and nitrogen content but reduced hydrogen concentration compared to a non-heat-treated sample.

Outcome of emergency endovascular treatment of large internal iliac artery aneurysms with guidewires

International Nuclear Information System (INIS)

Cambj-Sapunar, Liana; Maskovic, Josip; Brkljacic, Boris; Radonic, Vedran; Dragicevic, Dragan; Ajduk, Marko

2010-01-01

Purpose: Guidewires have been reported as a useful occlusion material for large aneurysms of different locations with good short-term results. In this study we retrospectively evaluate long-term results of emergency embolization technique with guidewires in symptomatic internal iliac artery aneurysm (IIAA) impending rupture. Patients and methods: In four patients presented with acute abdominal pain, multidetector computed tomography revealed unstable, 7-14 cm large, IIAAs. Two patients were treated with coil embolization of distal branches followed by occlusion of aneurysmal sac with guidewires. In two patients embolization of aneurysmal sac alone was performed. Results: In three patients complete or near complete occlusion of the aneurysmal sac was achieved and abdominal pain ceased within hours. Two patients treated with embolization of distal iliac artery branches and aneurysmal sac developed claudication that lasted up to 1 year. Their aneurysms remained thrombosed and they were without symptoms until they died 31 and 56 months later of causes unrelated to IIAA. Two patients treated with embolization of the aneurysm alone were free of ischemic symptoms. Because of incomplete embolization of the sac in one patient open surgery treatment in a non-emergency setting was performed. Complete filling of aneurysmal sac was achieved in other patient but 2 years later his aneurysm re-opened and required open surgery treatment. Conclusion: Embolization of aneurysmal sac of large IIAA with guidewires may be effective for immediate treatment of impending rupture. Long-term results were better when embolization of the aneurysmal sac was combined with embolization of distal IIA branches.

COPD, stage and treatment in a large outpatient clinic

DEFF Research Database (Denmark)

Holm, Claire Præst; Holm, Jakob; Nørgaard, Annette

2017-01-01

of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics...... was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62...

Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

International Nuclear Information System (INIS)

Guerrero, M; Li, X Allen

2003-01-01

Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to design new treatment strategies. The purpose of this work is to derive a plausible set of radiobiological parameters that can be used for RT treatment planning. The derivation is based on existing clinical data and is consistent with the analysis of a large number of published clinical studies on early-stage breast cancer. A large number of published clinical studies on the treatment of early breast cancer with BCS plus RT (including whole breast EBRT with or without a boost to the tumour bed, whole breast EBRT alone, brachytherapy alone) and RT alone are compiled and analysed. The linear quadratic (LQ) model is used in the analysis. Three of these clinical studies are selected to derive a plausible set of LQ parameters. The potential doubling time is set a priori in the derivation according to in vitro measurements from the literature. The impact of considering lower or higher T pot is investigated. The effects of inhomogeneous dose distributions are considered using clinically representative dose volume histograms. The derived LQ parameters are used to compare a large number of clinical studies using different regimes (e.g., RT modality and/or different fractionation schemes with different prescribed dose) in order to validate their applicability. The values of the equivalent uniform dose (EUD) and biologically effective dose (BED) are used as a common metric to compare the biological effectiveness of each treatment regime. We have obtained a plausible set of radiobiological parameters for breast cancer. This set of parameters is consistent with in vitro

Vapor and healing treatment for CH3NH3PbI3-xClx films toward large-area perovskite solar cells

Science.gov (United States)

Gouda, Laxman; Gottesman, Ronen; Tirosh, Shay; Haltzi, Eynav; Hu, Jiangang; Ginsburg, Adam; Keller, David A.; Bouhadana, Yaniv; Zaban, Arie

2016-03-01

Hybrid methyl-ammonium lead trihalide perovskites are promising low-cost materials for use in solar cells and other optoelectronic applications. With a certified photovoltaic conversion efficiency record of 20.1%, scale-up for commercial purposes is already underway. However, preparation of large-area perovskite films remains a challenge, and films of perovskites on large electrodes suffer from non-uniform performance. Thus, production and characterization of the lateral uniformity of large-area films is a crucial step towards scale-up of devices. In this paper, we present a reproducible method for improving the lateral uniformity and performance of large-area perovskite solar cells (32 cm2). The method is based on methyl-ammonium iodide (MAI) vapor treatment as a new step in the sequential deposition of perovskite films. Following the MAI vapor treatment, we used high throughput techniques to map the photovoltaic performance throughout the large-area device. The lateral uniformity and performance of all photovoltaic parameters (Voc, Jsc, Fill Factor, Photo-conversion efficiency) increased, with an overall improved photo-conversion efficiency of ~100% following a vapor treatment at 140 °C. Based on XRD and photoluminescence measurements, We propose that the MAI treatment promotes a ``healing effect'' to the perovskite film which increases the lateral uniformity across the large-area solar cell. Thus, the straightforward MAI vapor treatment is highly beneficial for large scale commercialization of perovskite solar cells, regardless of the specific deposition method.Hybrid methyl-ammonium lead trihalide perovskites are promising low-cost materials for use in solar cells and other optoelectronic applications. With a certified photovoltaic conversion efficiency record of 20.1%, scale-up for commercial purposes is already underway. However, preparation of large-area perovskite films remains a challenge, and films of perovskites on large electrodes suffer from non

Effect of high temperature heat treatments on the quality factor of a large-grain superconducting radio-frequency niobium cavity

Directory of Open Access Journals (Sweden)

P. Dhakal

2013-04-01

Full Text Available Large-grain Nb has become a viable alternative to fine-grain Nb for the fabrication of superconducting radio-frequency cavities. In this contribution we report the results from a heat treatment study of a large-grain 1.5 GHz single-cell cavity made of “medium purity” Nb. The baseline surface preparation prior to heat treatment consisted of standard buffered chemical polishing. The heat treatment in the range 800–1400°C was done in a newly designed vacuum induction furnace. Q_{0} values of the order of 2×10^{10} at 2.0 K and peak surface magnetic field (B_{p} of 90 mT were achieved reproducibly. A Q_{0} value of (5±1×10^{10} at 2.0 K and B_{p}=90  mT was obtained after heat treatment at 1400°C. This is the highest value ever reported at this temperature, frequency, and field. Samples heat treated with the cavity at 1400°C were analyzed by secondary ion mass spectrometry, x-ray photoelectron spectroscopy, energy dispersive x ray, point-contact tunneling, and x-ray diffraction, and revealed a complex surface composition which includes titanium oxide, increased carbon, and nitrogen content but reduced hydrogen concentration compared to a non-heat-treated sample.

Effect of high temperature heat treatments on the quality factor of a large-grain superconducting radio-frequency niobium cavity

Energy Technology Data Exchange (ETDEWEB)

Dhakal, P.; Ciovati, G.; Myneni, G. R.; Gray, K. E.; Groll, N.; Maheshwari, P.; McRae, D. M.; Pike, R.; Proslier, T.; Stevie, F.; Walsh, R. P.; Yang, Q.; Zasadzinzki, J.

2013-04-01

Large-grain Nb has become a viable alternative to fine-grain Nb for the fabrication of superconducting radio-frequency cavities. In this contribution we report the results from a heat treatment study of a large-grain 1.5 GHz single-cell cavity made of “medium purity” Nb. The baseline surface preparation prior to heat treatment consisted of standard buffered chemical polishing. The heat treatment in the range 800–1400°C was done in a newly designed vacuum induction furnace. Q{sub 0} values of the order of 2×10{sup 10} at 2.0 K and peak surface magnetic field (B{sub p}) of 90 mT were achieved reproducibly. A Q{sub 0} value of (5±1)×10{sup 10} at 2.0 K and B{sub p}=90mT was obtained after heat treatment at 1400°C. This is the highest value ever reported at this temperature, frequency, and field. Samples heat treated with the cavity at 1400°C were analyzed by secondary ion mass spectrometry, x-ray photoelectron spectroscopy, energy dispersive x ray, point-contact tunneling, and x-ray diffraction, and revealed a complex surface composition which includes titanium oxide, increased carbon, and nitrogen content but reduced hydrogen concentration compared to a non-heat-treated sample.

High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis

DEFF Research Database (Denmark)

Laursen, Jens Ole

2017-01-01

PURPOSE: The HemiCAP-Wave® implant for the patellofemoral resurfacing treatment of large cartilage lesions and osteoarthritis (OA) was introduced in 2009. The outcome of a prospective cohort study of 18 patients with large trochlea lesions or isolated OA treated with the HemiCAP-Wave® implant...... pain but high mid-term revision rate after patellofemoral inlay resurfacing using the HemiCAP-Wave® implant. Patellofemoral resurfacing implantation treatment with a large inlay prosthesis can offer temporary treatment for large isolated patellofemoral cartilage lesions or OA in younger patients...

Effective physical treatment for chronic low back pain.

Science.gov (United States)

Maher, C G

2004-01-01

It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future.

Pharmacogenetics of clozapine treatment response and side-effects in schizophrenia: an update.

Science.gov (United States)

Sriretnakumar, Venuja; Huang, Eric; Müller, Daniel J

2015-01-01

Clozapine (CLZ) is the most effective treatment for treatment-resistant schizophrenia (SCZ) patients, with potential added benefits of reduction in suicide risk and aggression. However, CLZ is also mainly underused due to its high risk for the potentially lethal side-effect of agranulocytosis as well as weight gain and related metabolic dysregulation. Pharmacogenetics promises to enable the prediction of patient treatment response and risk of adverse effects based on patients' genetics, paving the way toward individualized treatment. This article reviews pharmacogenetics studies of CLZ response and side-effects with a focus on articles from January 2012 to February 2015, as an update to the previous reviews. Pharmacokinetic genes explored primarily include CYP1A2, while pharmacodynamic genes consisted of traditional pharmacogenetic targets such as brain-derived neurotrophic factor as well novel mitochondrial genes, NDUFS-1 and translocator protein. Pharmacogenetics is a promising avenue for individualized medication of CLZ in SCZ, with several consistently replicated gene variants predicting CLZ response and side-effects. However, a large proportion of studies have yielded mixed results. Large-scale Genome-wide association studies (e.g., CRESTAR) and targeted gene studies with standardized designs (response measurements, treatment durations, plasma level monitoring) are required for further progress toward clinical translation. Additionally, in order to improve study quality, we recommend accounting for important confounders, including polypharmacy, baseline measurements, treatment duration, gender, and age at onset.

THERAPEUTIC EFFECT OF SOLASODINE RHAMNOSYL GLYCOSIDES FOR LARGE SKIN CANCERS: TWO CLINICAL CASES

Directory of Open Access Journals (Sweden)

Bill E. Cham

2012-01-01

Full Text Available Solasodine rhamnosyl glycosides (BEC are a new class of antineoplastics, the efficiency of which administered via intravenous, intraperitoneal, and intratumoral routes is higher than that of many other antitumor agents. Early investigations have established the efficiency of topical BEC applications as a treatment option for non-melanoma skin cancers. There have recently been two clinical cases that count in favor of the fact that the cream formulation Curaderm containing BEC has a very high efficacy in the treatment of large non-melanoma skin cancers that are incurable by other existing methods. Also, Curaderm treatment shows a splendid cosmetic effect. 

Large-scale multi-stage constructed wetlands for secondary effluents treatment in northern China: Carbon dynamics.

Science.gov (United States)

Wu, Haiming; Fan, Jinlin; Zhang, Jian; Ngo, Huu Hao; Guo, Wenshan

2018-02-01

Multi-stage constructed wetlands (CWs) have been proved to be a cost-effective alternative in the treatment of various wastewaters for improving the treatment performance as compared with the conventional single-stage CWs. However, few long-term full-scale multi-stage CWs have been performed and evaluated for polishing effluents from domestic wastewater treatment plants (WWTP). This study investigated the seasonal and spatial dynamics of carbon and the effects of the key factors (input loading and temperature) in the large-scale seven-stage Wu River CW polishing domestic WWTP effluents in northern China. The results indicated a significant improvement in water quality. Significant seasonal and spatial variations of organics removal were observed in the Wu River CW with a higher COD removal efficiency of 64-66% in summer and fall. Obvious seasonal and spatial variations of CH 4 and CO 2 emissions were also found with the average CH 4 and CO 2 emission rates of 3.78-35.54 mg m -2 d -1 and 610.78-8992.71 mg m -2 d -1 , respectively, while the higher CH 4 and CO 2 emission flux was obtained in spring and summer. Seasonal air temperatures and inflow COD loading rates significantly affected organics removal and CH 4 emission, but they appeared to have a weak influence on CO 2 emission. Overall, this study suggested that large-scale Wu River CW might be a potential source of GHG, but considering the sustainability of the multi-stage CW, the inflow COD loading rate of 1.8-2.0 g m -2 d -1 and temperature of 15-20 °C may be the suitable condition for achieving the higher organics removal efficiency and lower greenhouse gases (GHG) emission in polishing the domestic WWTP effluent. The obtained knowledge of the carbon dynamics in large-scale Wu River CW will be helpful for understanding the carbon cycles, but also can provide useful field experience for the design, operation and management of multi-stage CW treatments. Copyright © 2017 Elsevier Ltd. All rights

Large scale treatment of total petroleum-hydrocarbon contaminated groundwater using bioaugmentation.

Science.gov (United States)

Poi, Gregory; Shahsavari, Esmaeil; Aburto-Medina, Arturo; Mok, Puah Chum; Ball, Andrew S

2018-05-15

Bioaugmentation or the addition of microbes to contaminated sites has been widely used to treat contaminated soil or water; however this approach is often limited to laboratory based studies. In the present study, large scale bioaugmentation has been applied to total petroleum hydrocarbons (TPH)-contaminated groundwater at a petroleum facility. Initial TPH concentrations of 1564 mg L -1 in the field were reduced to 89 mg L -1 over 32 days. This reduction was accompanied by improved ecotoxicity, as shown by Brassica rapa germination numbers that increased from 52 at day 0 to 82% by the end of the treatment. Metagenomic analysis indicated that there was a shift in the microbial community when compared to the beginning of the treatment. The microbial community was dominated by Proteobacteria and Bacteroidetes from day 0 to day 32, although differences at the genus level were observed. The predominant genera at the beginning of the treatment (day 0 just after inoculation) were Cloacibacterium, Sediminibacterium and Brevundimonas while at the end of the treatment members of Flavobacterium dominated, reaching almost half the population (41%), followed by Pseudomonas (6%) and Limnobacter (5.8%). To the author's knowledge, this is among the first studies to report the successful large scale biodegradation of TPH-contaminated groundwater (18,000 L per treatment session) at an offshore petrochemical facility. Copyright © 2018 Elsevier Ltd. All rights reserved.

Literature Review: Herbal Medicine Treatment after Large-Scale Disasters.

Science.gov (United States)

Takayama, Shin; Kaneko, Soichiro; Numata, Takehiro; Kamiya, Tetsuharu; Arita, Ryutaro; Saito, Natsumi; Kikuchi, Akiko; Ohsawa, Minoru; Kohayagawa, Yoshitaka; Ishii, Tadashi

2017-01-01

Large-scale natural disasters, such as earthquakes, tsunamis, volcanic eruptions, and typhoons, occur worldwide. After the Great East Japan earthquake and tsunami, our medical support operation's experiences suggested that traditional medicine might be useful for treating the various symptoms of the survivors. However, little information is available regarding herbal medicine treatment in such situations. Considering that further disasters will occur, we performed a literature review and summarized the traditional medicine approaches for treatment after large-scale disasters. We searched PubMed and Cochrane Library for articles written in English, and Ichushi for those written in Japanese. Articles published before 31 March 2016 were included. Keywords "disaster" and "herbal medicine" were used in our search. Among studies involving herbal medicine after a disaster, we found two randomized controlled trials investigating post-traumatic stress disorder (PTSD), three retrospective investigations of trauma or common diseases, and seven case series or case reports of dizziness, pain, and psychosomatic symptoms. In conclusion, herbal medicine has been used to treat trauma, PTSD, and other symptoms after disasters. However, few articles have been published, likely due to the difficulty in designing high quality studies in such situations. Further study will be needed to clarify the usefulness of herbal medicine after disasters.

Negative effects of internet interventions: a qualitative content analysis of patients' experiences with treatments delivered online.

Science.gov (United States)

Rozental, Alexander; Boettcher, Johanna; Andersson, Gerhard; Schmidt, Brad; Carlbring, Per

2015-01-01

Internet interventions are defined as the delivery of health care-related treatments via an online or a smartphone interface, and have been shown to be a viable alternative to face-to-face treatments. However, not all patients benefit from such treatments, and it is possible that some may experience negative effects. Investigations of face-to-face treatments indicate that deterioration occurs in 5-10% of all patients. The nature and scope of other negative effects of Internet interventions is, however, largely unknown. Hence, the current study explored patients' reported negative experiences while undergoing treatments delivered via the Internet. Data from four large clinical trials (total N = 558) revealed that 9.3% of patients reported some type of negative effects. Qualitative content analysis was used to explore the patients' responses to open-ended questions regarding their negative experiences. Results yielded two broad categories and four subcategories of negative effects: patient-related negative effects (insight and symptom) and treatment-related negative effects (implementation and format). Results emphasize the importance of always considering negative effects in Internet-based interventions, and point to several ways of preventing such experiences, including regular assessment of negative events, increasing the flexibility of treatment schedules and therapist contact, as well as prolonging the treatment duration.

Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal

Directory of Open Access Journals (Sweden)

Kent David M

2010-08-01

Full Text Available Abstract Mounting evidence suggests that there is frequently considerable variation in the risk of the outcome of interest in clinical trial populations. These differences in risk will often cause clinically important heterogeneity in treatment effects (HTE across the trial population, such that the balance between treatment risks and benefits may differ substantially between large identifiable patient subgroups; the "average" benefit observed in the summary result may even be non-representative of the treatment effect for a typical patient in the trial. Conventional subgroup analyses, which examine whether specific patient characteristics modify the effects of treatment, are usually unable to detect even large variations in treatment benefit (and harm across risk groups because they do not account for the fact that patients have multiple characteristics simultaneously that affect the likelihood of treatment benefit. Based upon recent evidence on optimal statistical approaches to assessing HTE, we propose a framework that prioritizes the analysis and reporting of multivariate risk-based HTE and suggests that other subgroup analyses should be explicitly labeled either as primary subgroup analyses (well-motivated by prior evidence and intended to produce clinically actionable results or secondary (exploratory subgroup analyses (performed to inform future research. A standardized and transparent approach to HTE assessment and reporting could substantially improve clinical trial utility and interpretability.

Towards a framework for treatment effectiveness in schizophrenia

Directory of Open Access Journals (Sweden)

Juckel G

2014-09-01

Full Text Available Georg Juckel,1 Andrea de Bartolomeis,2 Philip Gorwood,3 Sergey Mosolov,4 Luca Pani,5 Alessandro Rossi,6 Julio Sanjuan7 1Department of Psychiatry, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany; 2Laboratory of Molecular Psychiatry and Unit of Treatment Resistant Psychosis, University School of Medicine of Naples Federico II, Napoli, Italy; 3Groupe Hospitalier Sainte-Anne (CMME, Paris-Descartes University, Paris, France; 4Moscow Research Institute of Psychiatry, Moscow, Russia; 5Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy; 6Università de L’Aquila, L’Aquila, Italy; 7Clinic Hospital, Spanish Mental Health Network (CIBERSAM, University of Valencia, Valencia, Spain Introduction: Prompt administration of antipsychotic treatment that is adhered to is essential for the optimal treatment of schizophrenia. Many patients have benefited from the advent of second-generation antipsychotics, which can offer good symptomatic control with reduced incidence of extrapyramidal symptoms, although with higher risk of metabolic side effects. It is unsurprising that accounts as to whether first- and second-generation antipsychotics differ in their efficacy vary, since treatment effectiveness is a broad notion and difficult to define. Objectives: Numerous factors may be used to gauge treatment effectiveness and, while it has largely been defined in terms of improvements in four domains (symptoms of disease, treatment burden, disease burden, and health and wellness, the real-world clinical utility of this consensus is unclear. Therefore, this article aims to provide a framework that can aid psychiatrists in making assessments about treatment effectiveness. Methods and results: A panel of 12 psychiatrists and psychopharmacologists convened to develop and propose an accessible and globally-applicable framework for assessing the effectiveness of antipsychotic treatments in patients with schizophrenia

Heat treatment effect on ductility of nickel-base alloys

International Nuclear Information System (INIS)

Burnakov, K.K.; Khasin, G.A.; Danilov, V.F.; Oshchepkov, B.V.; Listkova, A.I.

1979-01-01

Causes of low ductility of the KhN75MBTYu and KhN78T alloys were studied along with the heat treatment effects. Samples were tested at 20, 900, 1100, 1200 deg C. Large amount of inclusions was found in intercrystalline fractures of the above low-ductile alloys. The inclusions of two types took place: (α-Al 2 O 3 , FeO(Cr 2 O 3 xAl 2 O 3 )) dendrite-like ones and large-size laminated SiO 2 , FeO,(CrFe) 2 O 3 inclusions situated as separate colonies. Heat treatment of the alloys does not increase high-temperature impact strength and steel ductility. The heating above 1000 deg C leads to a partial dissolution and coagulation of film inclusions which results in an impact strength increase at room temperature

Environmental effects and large space systems

Science.gov (United States)

Garrett, H. B.

1981-01-01

When planning large scale operations in space, environmental impact must be considered in addition to radiation, spacecraft charging, contamination, high power and size. Pollution of the atmosphere and space is caused by rocket effluents and by photoelectrons generated by sunlight falling on satellite surfaces even light pollution may result (the SPS may reflect so much light as to be a nuisance to astronomers). Large (100 Km 2) structures also will absorb the high energy particles that impinge on them. Altogether, these effects may drastically alter the Earth's magnetosphere. It is not clear if these alterations will in any way affect the Earth's surface climate. Large structures will also generate large plasma wakes and waves which may cause interference with communications to the vehicle. A high energy, microwave beam from the SPS will cause ionospheric turbulence, affecting UHF and VHF communications. Although none of these effects may ultimately prove critical, they must be considered in the design of large structures.

A control study of TACE using high-dosed and routine-dosed iodized oil as a treatment of large hepatocellular carcinoma

International Nuclear Information System (INIS)

Zhou Junmin; Zhan Jincheng; Zhang Zhenming

2005-01-01

Objective: To investigate the side effects and curative effect in high-dosed lipiodol-transcatheter arterial chemoembolization as a treatment of large hepatocellular carcinoma. Methods: 79 patients with unresectable hepatocellular carcinoma were treated by TACE, and divided into 2 groups. In group A, 39 patients with the tumor sized 7-18cm in diameter, routine-dosed, 10-20ml lipiodol was given in TACE. 40 patients were enrolled in the high-dosed group B, who were given more than 20ml iodized oil in TACE. Results: The First to third year survival rate of group A was 66.7%, 33.3%, 0% respectively,while in group B it was 75%, 45%, 7.5% respectively. The effective rate was 71.7% in Group A and 87.5% in Group B. There was a significant difference between both groups. There was no significant difference of critical side effects and liver function damage between group A and B. Conclusion: High-dosed lipiodol chemoembolization as a treatment of unresectable hepatocellular carcinoma is superior to the routine TACE, especially when the tumor is large and the liver function reserve is good. (authors)

Weighing the potential effectiveness of various treatments for sleep bruxism.

Science.gov (United States)

Huynh, Nelly; Manzini, Christiane; Rompré, Pierre H; Lavigne, Gilles J

2007-10-01

Sleep bruxism may lead to a variety of problems, but its pathophysiology has not been completely elucidated. As such, there is no definitive treatment, but certain preventive measures and/or drugs may be used in acute cases, particularly those involving pain. This article is intended to guide clinician scientists to the treatment most appropriate for future clinical studies. To determine the best current treatment, 2 measures were used to compare the results of 10 clinical studies on sleep bruxism, 3 involving oral devices and 7 involving pharmacologic therapy. The first measure, the number needed to treat (NNT), allows several randomized clinical studies to be compared and a general conclusion to be drawn. The second measure, effect size, allows evaluation of the impact of treatment relative to a placebo using different studies of similar design. Taking into account the NNT, the effect size and the power of each study, it can be concluded that the following treatments reduce sleep bruxism: mandibular advancement device, clonidine and occlusal splint. However, the first 2 of these have been linked to adverse effects. The occlusal splint is therefore the treatment of choice, as it reduces grinding noise and protects the teeth from premature wear with no reported adverse effects. The NNT could not be calculated for an alternative pharmacologic treatment, short-term clonazepam therapy, which had a large effect size and reduced the average bruxism index. However, the risk of dependency limits its use over long periods. Assessment of efficacy and safety of the most promising treatments will require studies with larger sample sizes over longer periods.

Overview of a large-scale bioremediation soil treatment project

International Nuclear Information System (INIS)

Stechmann, R.

1991-01-01

How long does it take to remediate 290,000 yd 3 of impacted soil containing an average total petroleum hydrocarbon concentration of 3,000 ppm? Approximately 15 months from start to end of treatment using bioremediation. Mittelhauser was retained by the seller of the property (a major oil company) as technical manager to supervise remediation of a 45-ac parcel in the Los Angeles basin. Mittelhauser completed site characterization, negotiated clean-up levels with the regulatory agencies, and prepared the remedial action plan (RAP) with which the treatment approach was approved and permitted. The RAP outlined the excavation, treatment, and recompaction procedures for the impacted soil resulting from leakage of bunker fuel oil from a large surface impoundment. The impacted soil was treated on site in unline Land Treatment Units (LTUs) in 18-in.-thick lifts. Due to space restraints, multiple lifts site. The native microbial population was cultivated using soil stabilization mixing equipment with the application of water and agricultural grade fertilizers. Costs on this multimillion dollar project are broken down as follows: general contractor cost (47%), bioremediation subcontractor cost (35%), site characterization (10%), technical management (7%), analytical services (3%), RAP preparation and permitting (1%), and civil engineering subcontractor cost (1%). Start-up of field work could have been severely impacted by the existence of Red Fox habitation. The foxes were successfully relocated prior to start of field work

Large breast size as a risk factor for late adverse effects of breast radiotherapy: Is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation?

International Nuclear Information System (INIS)

Goldsmith, Christy; Haviland, Joanne; Tsang, Yat; Sydenham, Mark; Yarnold, John

2011-01-01

Background and Purpose: Large breast size is associated with an increased risk of late adverse effects after breast conservation surgery and radiotherapy, even when 3D dosimetry is used. The purpose of this study is to test the hypothesis that residual dose inhomogeneity is sufficient to explain the association. Methods: Patients previously treated after breast conservation surgery with whole breast radiotherapy using 3D dosimetry and followed up in the UK FAST hypofractionation trial were selected for this analysis. The residual level of dose inhomogeneity across the whole breast treatment volume was used to test for association between residual dosimetry and post-treatment change in breast appearance at 2 years post-radiotherapy. Results: At 2 years, 201/279 (72%) of women had no change in photographic breast appearance, 61 (22%) had mild change and 17 (6%) had marked change. Breast size and dosimetry were both significantly associated with late effects in univariate analyses, but only breast size remained an independent significant risk factor for change in breast appearance when included in a multiple regression model together with other prognostic factors (p = 0.006 for trend). Conclusion: Large-breasted women are more likely to suffer change in breast size and shape after whole breast radiotherapy delivered using 3D dosimetry, but residual dose inhomogeneity is insufficient to explain the association.

Effect of Heat Treatment Process on Mechanical Properties and Microstructure of a 9% Ni Steel for Large LNG Storage Tanks

Science.gov (United States)

Zhang, J. M.; Li, H.; Yang, F.; Chi, Q.; Ji, L. K.; Feng, Y. R.

2013-12-01

In this paper, two different heat treatment processes of a 9% Ni steel for large liquefied natural gas storage tanks were performed in an industrial heating furnace. The former was a special heat treatment process consisting of quenching and intercritical quenching and tempering (Q-IQ-T). The latter was a heat treatment process only consisting of quenching and tempering. Mechanical properties were measured by tensile testing and charpy impact testing, and the microstructure was analyzed by optical microscopy, transmission electron microscopy, and x-ray diffraction. The results showed that outstanding mechanical properties were obtained from the Q-IQ-T process in comparison with the Q-T process, and a cryogenic toughness with charpy impact energy value of 201 J was achieved at 77 K. Microstructure analysis revealed that samples of the Q-IQ-T process had about 9.8% of austenite in needle-like martensite, while samples of the Q-T process only had about 0.9% of austenite retained in tempered martensite.

Study of heat treatment parameters for large-scale hydraulic steel gate track

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Ping-zhou Cao

2013-10-01

Full Text Available In order to enhance external hardness and strength, a large-scale hydraulic gate track should go through heat treatment. The current design method of hydraulic gate wheels and tracks is based on Hertz contact linear elastic theory, and does not take into account the changes in mechanical properties of materials caused by heat treatment. In this study, the heat treatment parameters were designed and analyzed according to the bearing mechanisms of the wheel and track. The quenching process of the track was simulated by the ANSYS program, and the temperature variation, residual stress, and deformation were obtained and analyzed. The metallurgical structure field after heat treatment was predicted by the method based on time-temperature-transformation (TTT curves. The results show that the analysis method and designed track heat treatment process are feasible, and can provide a reference for practical projects.

Effects of heat treatment on density, dimensional stability and color ...

African Journals Online (AJOL)

The purpose of this study was to evaluate the effect of heat treatment on some physical properties and color change of Pinus nigra wood which has high industrial use potential and large growing stocks in Turkey. Wood samples which comprised the material of the study were obtained from an industrial plant. Samples were ...

[Effects of application of pulse contour cardiac output monitoring technology in early treatment of patients with large area burns].

Science.gov (United States)

Wang, D Y; Xie, W G; Xi, M M; Li, Z; Wang, B

2018-01-20

Objective: To analyze the changes and relationship of early hemodynamic indexes of patients with large area burns monitored by pulse contour cardiac output (PiCCO) monitoring technology, so as to assess the guiding value of this technology in the treatment of patients with large area burns during shock period. Methods: Eighteen patients with large area burns, confirming to the study criteria, were admitted to our unit from May 2016 to May 2017. Pulse contour cardiac output index (PCCI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), and extravascular lung water index (EVLWI) of patients were monitored by PiCCO instrument from admission to post injury day (PID) 7, and they were calibrated and recorded once every four hours. The fluid infusion coefficients of patients at the first and second 24 hours post injury were calculated. The blood lactic acid values of patients from PID 1 to 7 were also recorded. The correlations among PCCI, SVRI, and GEDVI as well as the correlation between SVRI and blood lactic acid of these 18 patients were analyzed. Prognosis of patients were recorded. Data were processed with one-way analysis of variance, single sample t test and Bonferroni correction, Pearson correlation analysis, and Spearman rank correlation analysis. Results: (1) There was statistically significant difference in PCCI value of patients from post injury hour (PIH) 4 to 168 ( F =7.428, P 0.05). (2) There was statistically significant difference in SVRI value of patients from PIH 4 to 168 ( F =7.863, P 0.05). (3) There was no statistically significant difference in the GEDVI values of patients from PIH 4 to 168 ( F =0.704, P >0.05). The GEDVI values of patients at PIH 8, 12, 16, 20, and 24 were significantly lower than normal value ( t =-3.112, -3.554, -2.969, -2.450, -2.476, P 0.05). (4) There was statistically significant difference in EVLWI value of patients from PIH 4 to 168 ( F =1.859, P 0.05). (5) The fluid infusion

Treatment of Previously Treated Facial Capillary Malformations: Results of Single-Center Retrospective Objective 3-Dimensional Analysis of the Efficacy of Large Spot 532 nm Lasers.

Science.gov (United States)

Kwiek, Bartłomiej; Ambroziak, Marcin; Osipowicz, Katarzyna; Kowalewski, Cezary; Rożalski, Michał

2018-06-01

Current treatment of facial capillary malformations (CM) has limited efficacy. To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis. Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. The median maximal improvement achieved during the treatment (GCE) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1-16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCE 37.3% vs 61.8%, respectively). A large spot 532 nm laser is effective in previously treated patients with facial CM.

Development of large bore superconducting magnet for wastewater treatment application

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Liu, Hui Ming; Xu, Dong; Shen, Fuzhi; Zhang, Hengcheng; Li, Lafeng [State Key Laboratory of Technologies in Space Cryogenic Propellants, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing (China)

2017-03-15

Water issue, especially water pollution, is a serious issue of 21st century. Being an significant technique for securing water resources, superconducting magnetic separation wastewater system was indispensable. A large bore conduction-cooled magnet was custom-tailored for wastewater treatment. The superconducting magnet has been designed, fabricated and tested. The superconducting magnet was composed of NbTi solenoid coils with an effective horizontal warm bore of 400 mm and a maximum central field of 2.56T. The superconducting magnet system was cooled by a two-stage 1.5W 4K GM cryocooler. The NbTi solenoid coils were wound around an aluminum former that is thermally connected to the second stage cold head of the cryocooler through a conductive copper link. The temperature distribution along the conductive link was measured during the cool-down process as well as at steady state. The magnet was cooled down to 4.8K in approximately 65 hours. The test of the magnetic field and quench analysis has been performed to verify the safe operation for the magnet system. Experimental results show that the superconducting magnet reached the designed magnetic performance.

RESOURCE SAVING TECHNOLOGICAL PROCESS OF LARGE-SIZE DIE THERMAL TREATMENT

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L. A. Glazkov

2009-01-01

Full Text Available The given paper presents a development of a technological process pertaining to hardening large-size parts made of die steel. The proposed process applies a water-air mixture instead of a conventional hardening medium that is industrial oil.While developing this new technological process it has been necessary to solve the following problems: reduction of thermal treatment duration, reduction of power resource expense (natural gas and mineral oil, elimination of fire danger and increase of process ecological efficiency. 

Effectiveness of botulinum toxin A in treatment of refractory erythromelalgia

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Kuan-Hsiang Lin

2013-05-01

Full Text Available Erythromelalgia is characterized by intense burning pain, erythema, and heat in affected areas after precipitating factors such as warm temperature or stress. It is refractory to treatment in some situations. We describe a woman with adenosquamous cell carcinoma of the lung and medically refractory erythromelalgia. The symptoms of erythromelalgia presented as refractory to any medical treatment. Due to the unresponsive nature of her condition, botulinum toxin type A (onabotulinumtoxin A was injected over both of her cheeks, periodically for six cycles. Her symptoms responded dramatically to subcutaneous and intradermal injection of botulinum toxin type A. Repetitive injection demonstrated consistent and reproducible responses, and the efficacy was maintained for approximately 1 month. No adverse effects or complications were noted. Botulinum toxin type A might be safe and effective as an alternative treatment for refractory erythromelalgia, but further large-scale studies are required.

Process evaluation of treatment times in a large radiotherapy department

International Nuclear Information System (INIS)

Beech, R.; Burgess, K.; Stratford, J.

2016-01-01

Purpose/objective: The Department of Health (DH) recognises access to appropriate and timely radiotherapy (RT) services as crucial in improving cancer patient outcomes, especially when facing a predicted increase in cancer diagnosis. There is a lack of ‘real-time’ data regarding daily demand of a linear accelerator, the impact of increasingly complex techniques on treatment times, and whether current scheduling reflects time needed for RT delivery, which would be valuable in highlighting current RT provision. Material/methods: A systematic quantitative process evaluation was undertaken in a large regional cancer centre, including a satellite centre, between January and April 2014. Data collected included treatment room-occupancy time, RT site, RT and verification technique and patient mobility status. Data was analysed descriptively; average room-occupancy times were calculated for RT techniques and compared to historical standardised treatment times within the department. Results: Room-occupancy was recorded for over 1300 fractions, over 50% of which overran their allotted treatment time. In a focused sample of 16 common techniques, 10 overran their allocated timeslots. Verification increased room-occupancy by six minutes (50%) over non-imaging. Treatments for patients requiring mobility assistance took four minutes (29%) longer. Conclusion: The majority of treatments overran their standardised timeslots. Although technique advancement has reduced RT delivery time, room-occupancy has not necessarily decreased. Verification increases room-occupancy and needs to be considered when moving towards adaptive techniques. Mobility affects room-occupancy and will become increasingly significant in an ageing population. This evaluation assesses validity of current treatment times in this department, and can be modified and repeated as necessary. - Highlights: • A process evaluation examined room-occupancy for various radiotherapy techniques. • Appointment lengths

The "3"2P applicator combined with propranolol in the treatment of large area skin capillary hemangiomain children

International Nuclear Information System (INIS)

Duan Yongqiang; Wu Zhenfu; Wu Min; Qiu Xuan; Fei Shinuan

2016-01-01

Objective: To investigate the clinical efficacy of "3"2P applicator plus propranolol in children with a large area of skin capillary hemangioma. Methods: Forty five cases of large hemangioma were divided into two groups. Control group of 20 patients recieved the conventional "3"2P application therapy. Of 20 cases in control group, there were 10 cases ≤3 years old children with hemangiomas, and 10 cases > 3 years old children with Port Wine Stain(PWS). Observation group of 25 cases recieved "3"2P applicator plus propranolol. Of 25 cases in observation group 10 cases werer ≤3 years old children with hemangiomas, 15 cases of children with PWS. Comparison was made between two different types of vascular tumors, treatment in ≤3 years old children and > 3 years old children, and adverse reactions. Data statistical analysis used χ"2 test and zero reaction test. P 0.05). The treatment efficacy in ≤3 years old children with infant hemangioma was 90.0% in control group and 100% in observation group (P > 0.05 ). The treatment efficacy for PWS in > 3 years old children was 40.0% in control group and 80% in observation group. Here the difference is statistically significant(P 3 years old children in control group,the treatment efficacy was 90.0% and 40.0%, respectively P 3 years old children in observation group, the treatment efficacy was 100.0% and 80.0% with no significant difference(P > 0.05). Complication of moist dermatitis was 25.0% in control group and 40.0% in observation group. Occurrence of depigmentation was 75.0% and 84.0% in control and observation group with no significant difference(P > 0.05). Changing in heart rate occurs in ≤3 years old children and > 3 years old children, 50.0% and 40.0%, respectively, with no significant difference(P > 0.05). Conclusion: "3"2P applicator plus propranolol treatment of refractory large hemangioma is simple, safe, and effective. But close attention needs to be paid to both "3"2P and propranolol on adverse reactions

Treatment of Large Bulla Formation after Tattoo Removal with a Q-Switched Laser

Science.gov (United States)

Kartono, Francisca; Desai, Alpesh; Kaur, Ravneet R.; Desai, Tejas

2010-01-01

Widely considered the gold standard treatment option for tattoo removal, the use of Q-switched lasers may very rarely result in the formation of large bulla. While very disconcerting to patients, these lesions are easily managed and, with proper care, heal quickly with no long-term consequences. The authors present three cases of patients who had bullous reactions shortly after receiving Q-switched laser treatment of tattoo ink. Bullous formation in all three patients was treated successfully. PMID:20725537

Effects of vacuum and controlled atmosphere treatments on insect mortality and lettuce quality.

Science.gov (United States)

Liu, Yong-Biao

2003-08-01

Laboratory studies were conducted to determine the effects of vacuum and controlled atmosphere on mortality of aphids, Nasonovia ribisnigri (Mosley) and Macrosiphum euphorbiae (Thomas), and leafminer, Liriomyza langei Frick, and on the visual quality of iceberg lettuce at three different temperatures. Vacuum at 50 mbar and controlled atmosphere with 6% CO2 were effective in controlling aphids and leafminer larvae. Complete control of N. ribisnigri and M. euphorbiae was achieved with vacuum treatments and 6% CO2 CA treatments at 5 degrees C in 4 d. Mortality was >96% when leafminer larvae were treated with vacuum and 6% CO2 CA treatments for 4 d. However, leafminer pupae were more tolerant to the treatments and highest mortality was close to 60% in 4 d with CO2 under vacuum. None of the treatments had negative effects on visual quality of iceberg lettuce. Results from this study are encouraging and warrant further and large-scale research.

Hypopigmentation Induced by Frequent Low-Fluence, Large-Spot-Size QS Nd:YAG Laser Treatments.

Science.gov (United States)

Wong, Yisheng; Lee, Siong See Joyce; Goh, Chee Leok

2015-12-01

The Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (QS 1064-nm Nd:YAG) laser is increasingly used for nonablative skin rejuvenation or "laser toning" for melasma. Multiple and frequent low-fluence, large-spot-size treatments are used to achieve laser toning, and these treatments are associated with the development of macular hypopigmentation as a complication. We present a case series of three patients who developed guttate hypomelanotic macules on the face after receiving laser toning treatment with QS 1064-nm Nd:YAG.

The treatment of late radiation effects with hyperbaric oxygenation (HBO)

International Nuclear Information System (INIS)

Plafki, C.; Carl, U.M.; Glag, M.; Hartmann, K.A.

1998-01-01

Background: Late radiation injuries may impose a negative influence on the quality of life in the affected patients. In several entities, standardized treatment protocols are lacking. Hyperbaric oxygenation (HBO) has been shown to have beneficial effects in the treatment of late radiation sequelae. Material and methods: The basic principles of HBO are reviewed as well as clinical issues. Current study protocols are presented. Results: During HBO-therapy the patient breathes pure oxygen at pressures above 100 kPa. The oxygen solubility within the fluid phase of the blood is largely increased. Biological effects include an increased oxygen diffusibility, improved collagen synthesis and neoangiogenesis as well as an enhancement of antimicrobial defenses. By decreasing the capillary filtration pressure a reduction of edema becomes possible. HBO has been shown to prevent complications following surgery in irradiated tissues. Its efficacy as an adjunct in the treatment of osteonecroses in radiation patients could be demonstrated. In addition, the loss of osseointegrated implants in the maxillofacial bones of these patients could be significantly reduced. Further indications include soft tissue necroses, hemorrhagic cystitis and proctitis in tumor patients that have been treated by radiotherapy as part of a multimodality approach. Conclusions: HBO in the treatment of late radiation effects is still subject of investigation, but remarkable results have been reported. Optimized treatment protocols need to be determined in various entities. The rate of side effects is acceptable low. (orig.) [de

Hydrogen Treatment for Superparamagnetic VO2 Nanowires with Large Room-Temperature Magnetoresistance.

Science.gov (United States)

Li, Zejun; Guo, Yuqiao; Hu, Zhenpeng; Su, Jihu; Zhao, Jiyin; Wu, Junchi; Wu, Jiajing; Zhao, Yingcheng; Wu, Changzheng; Xie, Yi

2016-07-04

One-dimensional (1D) transition metal oxide (TMO) nanostructures are actively pursued in spintronic devices owing to their nontrivial d electron magnetism and confined electron transport pathways. However, for TMOs, the realization of 1D structures with long-range magnetic order to achieve a sensitive magnetoelectric response near room temperature has been a longstanding challenge. Herein, we exploit a chemical hydric effect to regulate the spin structure of 1D V-V atomic chains in monoclinic VO2 nanowires. Hydrogen treatment introduced V(3+) (3d(2) ) ions into the 1D zigzag V-V chains, triggering the formation of ferromagnetically coupled V(3+) -V(4+) dimers to produce 1D superparamagnetic chains and achieve large room-temperature negative magnetoresistance (-23.9 %, 300 K, 0.5 T). This approach offers new opportunities to regulate the spin structure of 1D nanostructures to control the intrinsic magnetoelectric properties of spintronic materials. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Esophageal Large-Cell Neuroendocrine Carcinoma with Inconsistent Response to Treatment in the Primary and Metastatic Lesions

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Takashi Tomiyama

2018-05-01

Full Text Available Esophageal large-cell neuroendocrine carcinoma (NEC is a rare malignant tumor that is characterized by high-grade malignancy and a poor prognosis. However, the rarity of esophageal NEC has prevented the development of an established treatment, and no reports have described a discrepancy in the effectiveness of cisplatin plus irinotecan between primary and metastatic lesions. A 43-year-old Japanese man was referred to our hospital with refractory epigastralgia. A previous gastrointestinal endoscopy had revealed a 50-mm type 2 tumor in the abdominal esophagus. The pathological findings indicated poorly differentiated squamous cell carcinoma. Contrast-enhanced computed tomography revealed a metastatic liver tumor. One cycle of fluorouracil and cisplatin was not effective, and endoscopy was repeatedly performed. The pathological findings indicated a large-cell malignant tumor with tumor cells that were positive for CD56, synaptophysin, and Ki-67 (> 80%. Based on a diagnosis of esophageal large-cell NEC with a metastatic liver tumor, the patient received cisplatin plus irinotecan biweekly. After 4 months, computed tomography revealed marked shrinkage of the metastatic tumor, but the patient complained of dysphagia. Endoscopy revealed enlargement of the primary tumor, which was then treated using radiotherapy plus fluorouracil and cisplatin. The primary tumor subsequently shrank, and the patient’s symptoms were relieved, but the metastatic tumor grew. Thus, chemoradiotherapy could be an option for managing a primary esophageal large-cell NEC that does not respond to chemotherapy alone. However, the possibility of an inconsistent response to therapy in primary and metastatic lesions should be considered.

Large-scale experience with biological treatment of contaminated soil

International Nuclear Information System (INIS)

Schulz-Berendt, V.; Poetzsch, E.

1995-01-01

The efficiency of biological methods for the cleanup of soil contaminated with total petroleum hydrocarbons (TPH) and polycyclic aromatic hydrocarbons (PAH) was demonstrated by a large-scale example in which 38,000 tons of TPH- and PAH-polluted soil was treated onsite with the TERRAFERM reg-sign degradation system to reach the target values of 300 mg/kg TPH and 5 mg/kg PAH. Detection of the ecotoxicological potential (Microtox reg-sign assay) showed a significant decrease during the remediation. Low concentrations of PAH in the ground were treated by an in situ technology. The in situ treatment was combined with mechanical measures (slurry wall) to prevent the contamination from dispersing from the site

Achieving a table-like magnetocaloric effect and large refrigerant capacity in in situ multiphase Gd65Mn25Si10 alloys obtained by crystallization treatment

International Nuclear Information System (INIS)

Shen, X Y; Zhong, X C; Huang, X W; Mo, H Y; Feng, X L; Liu, Z W; Jiao, D L

2017-01-01

In situ multiphase structure Gd 65 Mn 25 Si 10 alloys were fabricated by melt spinning and subsequent crystallization treatment. In the process of crystallization, the α -Gd, GdMn 2 and Gd 5 Si 3 phases precipitate in the amorphous matrix in turn. The Curie temperature ( T C ) values for the α -Gd crystallization phase and amorphous matrix can be tailored by tuning the crystallization treatment time. All three multiphase alloys obtained by crystallization treatment at 637 K for 20, 30 and 40 min, respectively, undergo multiple successive magnetic phase transitions. A table-like magnetic entropy change over a wide temperature range (∼90–120 K) and a large full width at half maximum (Δ T FWHM ) magnetic entropy change (∼230 K) were achieved in the above-mentioned crystallized alloys, resulting in large refrigerant capacities (RCs). The enhanced RCs of the three crystallized alloys for a magnetic field change of 0–5 T are in the range of 541–614 J kg −1 . Large Δ T FWHM and RC values and a table-like (−Δ S M ) max feature obtained in in situ multiphase Gd 65 Mn 25 Si 10 crystallized alloys make them suitable for potential application in efficient Ericsson-cycle magnetic refrigeration working in a temperature range from 74 to 310 K. (paper)

Robust estimation of the proportion of treatment effect explained by surrogate marker information.

Science.gov (United States)

Parast, Layla; McDermott, Mary M; Tian, Lu

2016-05-10

In randomized treatment studies where the primary outcome requires long follow-up of patients and/or expensive or invasive obtainment procedures, the availability of a surrogate marker that could be used to estimate the treatment effect and could potentially be observed earlier than the primary outcome would allow researchers to make conclusions regarding the treatment effect with less required follow-up time and resources. The Prentice criterion for a valid surrogate marker requires that a test for treatment effect on the surrogate marker also be a valid test for treatment effect on the primary outcome of interest. Based on this criterion, methods have been developed to define and estimate the proportion of treatment effect on the primary outcome that is explained by the treatment effect on the surrogate marker. These methods aim to identify useful statistical surrogates that capture a large proportion of the treatment effect. However, current methods to estimate this proportion usually require restrictive model assumptions that may not hold in practice and thus may lead to biased estimates of this quantity. In this paper, we propose a nonparametric procedure to estimate the proportion of treatment effect on the primary outcome that is explained by the treatment effect on a potential surrogate marker and extend this procedure to a setting with multiple surrogate markers. We compare our approach with previously proposed model-based approaches and propose a variance estimation procedure based on a perturbation-resampling method. Simulation studies demonstrate that the procedure performs well in finite samples and outperforms model-based procedures when the specified models are not correct. We illustrate our proposed procedure using a data set from a randomized study investigating a group-mediated cognitive behavioral intervention for peripheral artery disease participants. Copyright © 2015 John Wiley & Sons, Ltd.

Large cavernous hemangioma of the adrenal gland: Laparoscopic treatment. Report of a case

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A. Agrusa

2015-01-01

Conclusion: Laparoscopic adrenalectomy is considered the standard treatment in case of diagnosis of benign lesions. In this case report we discussed a large adrenal cavernous hemangioma treated with laparoscopic approach. Fundamental is the study of preoperative endocrine disorders and radiologic findings to exclude signs of malignancy.

Multidose Stereotactic Radiosurgery (9 Gy × 3) of the Postoperative Resection Cavity for Treatment of Large Brain Metastases

Energy Technology Data Exchange (ETDEWEB)

Minniti, Giuseppe, E-mail: gminniti@ospedalesantandrea.it [Radiation Oncology Unit, Sant' Andrea Hospital, University “Sapienza,” Rome (Italy); Department of Neurological Sciences, Scientific Institute IRCCS Neuromed, Pozzilli (Italy); Esposito, Vincenzo [Department of Neurological Sciences, Scientific Institute IRCCS Neuromed, Pozzilli (Italy); Clarke, Enrico; Scaringi, Claudia [Radiation Oncology Unit, Sant' Andrea Hospital, University “Sapienza,” Rome (Italy); Lanzetta, Gaetano [Department of Neurological Sciences, Scientific Institute IRCCS Neuromed, Pozzilli (Italy); Salvati, Maurizio [Department of Neurological Sciences, Scientific Institute IRCCS Neuromed, Pozzilli (Italy); Neurosurgery Unit, Umberto I Hospital, University “Sapienza,” Rome (Italy); Raco, Antonino [Neurosurgery Unit, Sant' Andrea Hospital, University “Sapienza,” Rome (Italy); Bozzao, Alessandro [Neuroradiology Unit, Sant' Andrea Hospital, University “Sapienza,” Rome (Italy); Maurizi Enrici, Riccardo [Radiation Oncology Unit, Sant' Andrea Hospital, University “Sapienza,” Rome (Italy)

2013-07-15

Purpose: To evaluate the clinical outcomes with linear accelerator-based multidose stereotactic radiosurgery (SRS) to large postoperative resection cavities in patients with large brain metastases. Methods and Materials: Between March 2005 to May 2012, 101 patients with a single brain metastasis were treated with surgery and multidose SRS (9 Gy × 3) for large resection cavities (>3 cm). The target volume was the resection cavity with the inclusion of a 2-mm margin. The median cavity volume was 17.5 cm{sup 3} (range, 12.6-35.7 cm{sup 3}). The primary endpoint was local control. Secondary endpoints were survival and distant failure rates, cause of death, performance measurements, and toxicity of treatment. Results: With a median follow-up of 16 months (range, 6-44 months), the 1-year and 2-year actuarial survival rates were 69% and 34%, respectively. The 1-year and 2-year local control rates were 93% and 84%, with respective incidences of new distant brain metastases of 50% and 66%. Local control was similar for radiosensitive (non-small cell lung cancer and breast cancer) and radioresistant (melanoma and renal cell cancer) brain metastases. On multivariate Cox analysis stable extracranial disease, breast cancer histology, and Karnofsky performance status >70 were associated with significant survival benefit. Brain radionecrosis occurred in 9 patients (9%), being symptomatic in 5 patients (5%). Conclusions: Adjuvant multidose SRS to resection cavity represents an effective treatment option that achieves excellent local control and defers the use of whole-brain radiation therapy in selected patients with large brain metastases.

Effects of alcoholic beverage treatment on spatial learning and fear memory in mice.

Science.gov (United States)

Hashikawa-Hobara, Narumi; Mishima, Shuta; Nagase, Shotaro; Morita, Keishi; Otsuka, Ami; Hashikawa, Naoya

2018-04-24

Although chronic ethanol treatment is known to impair learning and memory, humans commonly consume a range of alcoholic beverages. However, the specific effects of some alcoholic beverages on behavioral performance are largely unknown. The present study compared the effects of a range of alcoholic beverages (plain ethanol solution, red wine, sake and whiskey; with a matched alcohol concentration of 10%) on learning and memory. 6-week-old C57BL6J mice were orally administered alcohol for 7 weeks. The results revealed that red wine treatment exhibited a trend toward improvement of spatial memory and advanced extinction of fear memory. Additionally, red wine treatment significantly increased mRNA levels of brain-derived neurotrophic factor (BDNF) and N-methyl-D-aspartate (NMDA) receptors in mice hippocampus. These results support previous reports that red wine has beneficial effects.

Large magnetoresistance effect in nitrogen-doped silicon

Directory of Open Access Journals (Sweden)

Tao Wang

2017-05-01

Full Text Available In this work, we reported a large magnetoresistance effect in silicon by ion implantation of nitrogen atoms. At room temperature, the magnetoresistance of silicon reaches 125 % under magnetic field 1.7 T and voltage bias -80 V. By applying an alternating magnetic field with a frequency (f of 0.008 Hz, we find that the magnetoresistance of silicon is divided into f and 2f two signal components, which represent the linear and quadratic magnetoresistance effects, respectively. The analysis based on tuning the magnetic field and the voltage bias reveals that electric-field-induced space-charge effect plays an important role to enhance both the linear and quadratic magnetoresistance effects. Observation as well as a comprehensive explanation of large MR in silicon, especially based on semiconductor CMOS implantation technology, will be an important progress towards magnetoelectronic applications.

Increased risk of gastric adenocarcinoma after treatment of primary gastric diffuse large B-cell lymphoma

International Nuclear Information System (INIS)

Inaba, Koji; Morota, Madoka; Mayahara, Hiroshi; Ito, Yoshinori; Sumi, Minako; Uno, Takashi; Itami, Jun; Kushima, Ryoji; Murakami, Naoya; Kuroda, Yuuki; Harada, Ken; Kitaguchi, Mayuka; Yoshio, Kotaro; Sekii, Shuhei; Takahashi, Kana

2013-01-01

There have been sporadic reports about synchronous as well as metachronous gastric adenocarcinoma and primary gastric lymphoma. Many reports have dealt with metachronous gastric adenocarcinoma in mucosa-associated lymphoid tissue lymphoma of stomach. But to our knowledge, there have been no reports that document the increased incidence of metachronous gastric adenocarcinoma in patients with gastric diffuse large B-cell lymphoma. This retrospective study was conducted to estimate the incidence of metachronous gastric adenocarcinoma after primary gastric lymphoma treatment, especially in diffuse large B-cell lymphoma. The retrospective cohort study of 139 primary gastric lymphoma patients treated with radiotherapy at our hospital. Mean observation period was 61.5 months (range: 3.7-124.6 months). Patients profile, characteristics of primary gastric lymphoma and metachronous gastric adenocarcinoma were retrieved from medical records. The risk of metachronous gastric adenocarcinoma was compared with the risk of gastric adenocarcinoma in Japanese population. There were 10 (7.2%) metachronous gastric adenocarcinoma patients after treatment of primary gastric lymphomas. It was quite high risk compared with the risk of gastric carcinoma in Japanese population of 54.7/100,000. Seven patients of 10 were diffuse large B-cell lymphoma and other 3 patients were mixed type of diffuse large B-cell lymphoma and mucosa associated lymphoid tissue lymphoma. Four patients of 10 metachronous gastric adenocarcinomas were signet-ring cell carcinoma and two patients died of gastric adenocarcinoma. Metachronous gastric adenocarcinoma may have a more malignant potential than sporadic gastric adenocarcinoma. Old age, Helicobacter pylori infection and gastric mucosal change of chronic gastritis and intestinal metaplasia were possible risk factors for metachronous gastric adenocarcinoma. There was an increased risk of gastric adenocarcinoma after treatment of primary gastric lymphoma

Clinical characteristics and treatment results of large cell lung cancer-62 case report

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Chen Dongfu; Ou Guangfei; Cheng Guiyu; Zhou Zongmei; Zhao Lujun; Wang Lvhua

2004-01-01

Objective: Objective To evaluate the clinical characteristics and treatment results of 60 patients with large cell lung cancer (LCLC). Methods: All sixty-two patients were diagnosed histopathologically with 5 in stage I, 13 in stage II, 30 in stage III and 14 in stage IV. Forty-five patients received primary surgical resection with 38 radical resection and 7 palliative resection. Non-surgical treatment was given to 17 patients. Mediastinum and ipsilateral hilum were treated to the total dose of 40-60 Gy in 4-6 weeks in 16 patients as postoperative adjuvant radiotherapy. For patients treated by radiation alone, the primary tumor bed, bilateral mediastinum and ipsilateral hilum were treated to the total dose of 36-70 Gy in 4-7 weeks. Results: The overall 1-, 3- and 5- year survival rates were 25.7%, 15.4% and 11.6%, respectively with the median survival time of 11.6 months. In the radically resected patients, the 1-, 3- and 5-year survival rates and the median survival time were 51.3%, 24.7%, 24.7% and 13 months, compared to those of 0%, 0%, 0% and 2 months in the palliatively resected group. In non-surgical treatment group, the 1-, 3- and 5-year survival rates and the median survival time were 41.2%, 21.2%, 7.0% and 11 months, respectively. Conclusions: The prognosis of large cell lung cancer is poor due to high distant metastasis rate. The long-term survival rate after radical resection is worse than the other lung cancers, but similar to the non-surgical treatment. (authors)

Primary cutaneous anaplastic large-cell lymphoma.

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Perry, Edward; Karajgikar, Jay; Tabbara, Imad A

2013-10-01

Since the recognition of the anaplastic large-cell lymphomas in the 1980s, much has been learned about the diagnosis, clinical presentation, and treatment of these malignant conditions. The systemic and primary cutaneous types of anaplastic large cell lymphomas have been differentiated on clinical and immunophenotypical findings, but further research is required to elucidate their exact etiologies and pathogeneses. Primary cutaneous anaplastic large-cell lymphoma has a 95% disease-specific 5-year survival, owing partly to the relatively benign course of the disease and partly to the variety of effective treatments that are available. As with many other oncological diseases, new drugs are continually being tested and developed, with immunotherapy and biological response modifiers showing promise.

An Enzymatic Treatment of Soil-Bound Prions Effectively Inhibits Replication ▿

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Saunders, Samuel E.; Bartz, Jason C.; Vercauteren, Kurt C.; Bartelt-Hunt, Shannon L.

2011-01-01

Chronic wasting disease (CWD) and scrapie can be transmitted through indirect environmental routes, possibly via soil, and a practical decontamination strategy for prion-contaminated soil is currently unavailable. In the laboratory, an enzymatic treatment under environmentally relevant conditions (22°C, pH 7.4) can degrade soil-bound PrPSc below the limits of Western blot detection. We developed and used a quantitative serial protein misfolding cyclic amplification (PMCA) protocol to characterize the amplification efficiency of treated soil samples relative to controls of known infectious titer. Our results suggest large (104- to >106-fold) decreases in soil-bound prion infectivity following enzyme treatment, demonstrating that a mild enzymatic treatment could effectively reduce the risk of prion disease transmission via soil or other environmental surfaces. PMID:21571886

AN EXPLORATORY STUDY INVESTIGATING THE EFFECTS OF A TREATMENT MANUAL FOR VIDEO GAME ADDICTION.

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Pallesen, Ståle; Lorvik, Ingjerd Meen; Bu, Eli Hellandsjø; Molde, Helge

2015-10-01

This study investigated the effects of a manualized therapy for video game addiction in 12 males, ages 14-18 yr. The manual was based on cognitive-behavioral therapy, short-term strategic family therapy, solution-focused therapy, and motivational interviewing. Treatment response was reported by the patients, their mothers, and the therapists. The patients reported moderate (but statistically non-significant) improvement from pre- to post-treatment. The mothers, however, reported large effects and statistically significant improvement from pre- to post-treatment. The therapists reported marked or moderate treatment response in six of the 12 patients. The ratings of change by mothers converged well with the views of change of both the patients and therapists, whereas the convergence of views on change between the two latter sources was far lower.

The effects of Strongylus vulgaris parasitism on eosinophil distribution and accumulation in equine large intestinal mucosa.

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Rötting, A K; Freeman, D E; Constable, P D; Moore, R M; Eurell, J C; Wallig, M A; Hubert, J D

2008-06-01

Eosinophilic granulocytes have been associated with parasite or immune-mediated diseases, but their functions in other disease processes remain unclear. Cause and timing of eosinophil migration into the equine gastrointestinal mucosa are also unknown. To determine the effects of intestinal parasitism on eosinophils in equine large intestinal mucosa. Large intestinal mucosal samples were collected from horses and ponies (n = 16) from the general veterinary hospital population, ponies (n = 3) raised in a parasite-free environment, ponies experimentally infected with 500 infective Strongylus vulgaris larvae and treated with a proprietary anthelmintic drug (n = 14), and a similar group of ponies (n = 7) that received no anthelmintic treatment. Total eosinophil counts and eosinophil distribution in the mucosa were determined by histological examination. A mixed model analysis was performed and appropriate Bonferroni adjusted P values used for each family of comparisons. Pvulgaris and those raised in a parasite-free environment. Experimental infection with S. vulgaris, with or without subsequent anthelmintic treatment, did not change eosinophil counts, and counts were similar to those for horses from the general population. Migration of eosinophils to the equine large intestinal mucosa appears to be independent of exposure to parasites. Large intestinal mucosal eosinophils may have more functions in addition to their role in defence against parasites.

Power analysis to detect treatment effects in longitudinal clinical trials for Alzheimer's disease.

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Huang, Zhiyue; Muniz-Terrera, Graciela; Tom, Brian D M

2017-09-01

Assessing cognitive and functional changes at the early stage of Alzheimer's disease (AD) and detecting treatment effects in clinical trials for early AD are challenging. Under the assumption that transformed versions of the Mini-Mental State Examination, the Clinical Dementia Rating Scale-Sum of Boxes, and the Alzheimer's Disease Assessment Scale-Cognitive Subscale tests'/components' scores are from a multivariate linear mixed-effects model, we calculated the sample sizes required to detect treatment effects on the annual rates of change in these three components in clinical trials for participants with mild cognitive impairment. Our results suggest that a large number of participants would be required to detect a clinically meaningful treatment effect in a population with preclinical or prodromal Alzheimer's disease. We found that the transformed Mini-Mental State Examination is more sensitive for detecting treatment effects in early AD than the transformed Clinical Dementia Rating Scale-Sum of Boxes and Alzheimer's Disease Assessment Scale-Cognitive Subscale. The use of optimal weights to construct powerful test statistics or sensitive composite scores/endpoints can reduce the required sample sizes needed for clinical trials. Consideration of the multivariate/joint distribution of components' scores rather than the distribution of a single composite score when designing clinical trials can lead to an increase in power and reduced sample sizes for detecting treatment effects in clinical trials for early AD.

Type 1 Retinopathy of Prematurity and Its Laser Treatment of Large Preterm Infants in East China.

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Shan, Haidong; Ni, Yinqing; Xue, Kang; Yu, Jia; Huang, Xin

2015-01-01

To describe Type 1 retinopathy of prematurity (ROP) and its laser treatment outcomes in premature infants with birth weight > 1250 g in Eastern China. A retrospective review of 3175 ROP records was conducted at Shanghai Eye & ENT Hospital of Fudan University. The records were collected at the ROP clinic from 2006 to 2014, including their demographic and medical information such as gestational age, birth weight, supplemental oxygen therapy, systemic complications, ROP stage, location, presence of plus disease. All infants were examined by RetCam fundus camera. Those with Type 1 ROP were also examined by indirect ophthalmoscope before undergoing transpupillary laser treatment. A total of 12 infants (24 eyes) with Type 1 ROP and birth weight > 1250 g were enrolled. All infants enrolled had plus disease and ROP in zone II retina. Specifically, 16 eyes (67%) had stage 2 ROP. 8 eyes (33%) had stage 3 ROP. ROP regressed in 23 eyes (96%) following laser treatment. Partial retinal detachment developed in one eye (4%). No severe involution sequelaes or laser-related complications were recorded. Mean follow-up was 30±6 weeks. Type 1 ROP may occur in large premature infants who have undergone supplemental oxygen therapy. This Type 1 ROP is mainly located in zone II retina. Laser treatment is a safe and effective intervention for these infants.

Effects of large herbivores on grassland arthropod diversity.

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van Klink, R; van der Plas, F; van Noordwijk, C G E Toos; WallisDeVries, M F; Olff, H

2015-05-01

Both arthropods and large grazing herbivores are important components and drivers of biodiversity in grassland ecosystems, but a synthesis of how arthropod diversity is affected by large herbivores has been largely missing. To fill this gap, we conducted a literature search, which yielded 141 studies on this topic of which 24 simultaneously investigated plant and arthropod diversity. Using the data from these 24 studies, we compared the responses of plant and arthropod diversity to an increase in grazing intensity. This quantitative assessment showed no overall significant effect of increasing grazing intensity on plant diversity, while arthropod diversity was generally negatively affected. To understand these negative effects, we explored the mechanisms by which large herbivores affect arthropod communities: direct effects, changes in vegetation structure, changes in plant community composition, changes in soil conditions, and cascading effects within the arthropod interaction web. We identify three main factors determining the effects of large herbivores on arthropod diversity: (i) unintentional predation and increased disturbance, (ii) decreases in total resource abundance for arthropods (biomass) and (iii) changes in plant diversity, vegetation structure and abiotic conditions. In general, heterogeneity in vegetation structure and abiotic conditions increases at intermediate grazing intensity, but declines at both low and high grazing intensity. We conclude that large herbivores can only increase arthropod diversity if they cause an increase in (a)biotic heterogeneity, and then only if this increase is large enough to compensate for the loss of total resource abundance and the increased mortality rate. This is expected to occur only at low herbivore densities or with spatio-temporal variation in herbivore densities. As we demonstrate that arthropod diversity is often more negatively affected by grazing than plant diversity, we strongly recommend considering the

Personality does not predict treatment preference, treatment experience does: a study of four complementary pain treatments.

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Blasche, Gerhard; Melchart, Herbert; Leitner, Daniela; Marktl, Wolfgang

2007-10-01

The aim of the present study was to determine the extent to which personality and treatment experience affect patients' appraisals of 4 complementary treatments for chronic pain. A total of 232 chronic pain patients (164 females, 68 males, average age 56.6 years) visiting a spa clinic in Austria returned a questionnaire on patient characteristics and personality (autonomy, depressiveness, assertiveness, self-control) as well as attitudes towards (i.e. appealing, effective, pleasant) and experience of the treatments. Results were analysed by use of linear regression analysis and confidence intervals. Although all treatments were appraised positively, the passive treatments (thermal water tub baths, classical massage) were favoured more than the active treatments (relaxation training or exercise therapy). Treatment appraisal was not predicted by any of the personality traits but to a large extent by treatment experience. Relaxing, not unpleasant treatments were the most highly esteemed treatments. How strenuous or tiring a treatment was only had a minor effect on its appraisal. Neither do dependent, passive patients prefer passive treatments, nor do conscientious patients prefer active treatments. Instead, the appraisal of treatments that induce specific somatosensory sensations is largely determined by treatment experiences, i.e. what the treatment feels like. Despite the popularity of CAM which encompasses many experientially intensive treatments, treatment experience has to date been a neglected topic of treatment research.

Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service

International Nuclear Information System (INIS)

McCusker, M.W.; Robinson, S.; Looby, S.; Power, S.; Ti, J.P.; Grech, R.; Galvin, L.; O'Hare, A.; Brennan, P.; O'Kelly, P.; O'Brien, P.; Collins, R.; Dolan, E.; Williams, D.J.; Thornton, J.

2015-01-01

Aim: To report the experience of a regional stroke referral service with endovascular treatment for patients with acute ischaemic stroke (AIS) and large vessel occlusion. Materials and methods: A prospective review was undertaken of 93 consecutive cases receiving endovascular treatment for AIS over a 42-month period (January 2010 to June 2013). The National Institutes of Health Stroke Scale (NIHSS), location of large vessel occlusion, details of endovascular procedure, and degree of reperfusion achieved (Thrombolysis In Cerebral Infarction [TICI] score) were recorded. Mortality and functional outcome (modified Rankin Scale [mRS]) were measured at 90 days. Results: The mean patient age was 62 years (range 26–87 years). The mean NIHSS at presentation was 16 (range 6–29). All patients had confirmed proximal large-artery occlusion on computed tomography (CT) angiography: 87 in the anterior circulation, six in the posterior circulation. Of the 93 patients treated, 64 (69%) received intravenous thrombolysis. Successful reperfusion (TICI grade 2a to 3) was achieved in 80 (86%) cases. There were 13 (14%) cases of failed vessel recanalisation (TICI grade 0). Good functional outcome (mRS ≤2) was achieved in 51 (55%) cases. The 90-day mortality was 20 (22%) cases. Fifty-seven (61%) cases were transferred from outside centres. There was no significant increase in morbidity or mortality for transferred patients. Conclusion: Successful endovascular recanalisation can result in good functional outcomes for patients with AIS and large vessel occlusion. Our interventional neuroradiology service provides endovascular treatment as part of a regional stroke service without increase in morbidity or mortality for patients transferred from outside institutions. - Highlights: • Acute stoke patients may benefit from transfer to a specialist centre for endovascular treatment. • The authors offer endovascular treatment for suitable patients as part of a regional stroke service. �

Recent quality of ultra large rotor shafts

International Nuclear Information System (INIS)

Suzuki, Akira; Kinoshita, Shushi; Morita, Kikuo; Kikuchi, Hideo; Takada, Masayoshi

1983-01-01

Large size and high quality are required for rotor shafts accompanying recent trend of thermal and nuclear power generation toward large capacity. As for the low pressure rotor shafts for large capacity turbines, the disks and a shaft tend to be made into one body instead of conventional shrink fit construction, because of the experience of rotor accidents and the improvement of reliability. Therefore the ingots required become more and more large, and excellent production techniques are required for steel making, forging and heat treatment. Kobe Steel Ltd. have made about 20 large generator shafts from 420 t and 500 t ingots, and confirmed their stable high quality. Also a one-body low pressure rotor of 2600 mm diameter was made for trial, and its quality was examined. It was confirmed that the effect of forging and heat treatment was given sufficiently, and the production techniques for super-large one-body rotors were established. In steel making, vacuum degassing was applied twice to decrease hydrogen content, and VV restriction forging and pre-stage treatment were carried out. The properties of large rotors are reported. (Kako, I.)

Interpreting small treatment differences from quality of life data in cancer trials: an alternative measure of treatment benefit and effect size for the EORTC-QLQ-C30.

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Khan, Iftekhar; Bashir, Zahid; Forster, Martin

2015-11-14

The EORTC-QLQ-C30 is a widely used health related quality of life (HRQoL) questionnaire in lung cancer patients. Small HRQoL treatment effects are often reported as mean differences (MDs) between treatments, which are rarely justified or understood by patients and clinicians. An alternative approach using odds ratios (OR) for reporting effects is proposed. This may offer advantages including facilitating alignment between patient and clinician understanding of HRQoL effects. Data from six CRUK sponsored randomized controlled lung cancer trials (2 small cell and 4 in non-small cell, in 2909 patients) were used to HRQoL effects. Results from Beta-Binomial (BB) standard mixed effects were compared. Preferences for ORs vs MDs were determined and Time to Deterioration (TD) was also compared. HRQoL effects using ORs offered coherent interpretations: MDs >0 resulted in ORs >1 and vice versa; effect sizes were classified as 'Trivial' if the OR was between 1 ± 0.05 (i.e. 0.95 to 1.05); 'Small': for 1 ± 0.1; 'Medium': 1 ± 0.2 and 'Large': OR 1.20. Small HRQoL effects on the MD scale may translate to important treatment differences on the OR scale: for example, a worsening in symptoms (MD) by 2.6 points (p = 0.1314) would be a 17 % deterioration (p small ORs are unlikely to yield large MDs because methods based on OR model skewed data well. Initial evidence also suggests oncologists prefer ORs over MDs since interpretation is similar to hazard ratios. Reporting HRQoL benefits as MDs can be misleading. Estimates of HRQoL treatment effects in terms of ORs are preferred over MDs. Future analysis of QLQ-C30 and other HRQoL measures should consider reporting HRQoL treatment effects as ORs.

The costs and cost-effectiveness of an integrated sepsis treatment protocol.

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Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

2008-04-01

Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility.

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Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

2004-01-01

The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

Forest landscape models, a tool for understanding the effect of the large-scale and long-term landscape processes

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Hong S. He; Robert E. Keane; Louis R. Iverson

2008-01-01

Forest landscape models have become important tools for understanding large-scale and long-term landscape (spatial) processes such as climate change, fire, windthrow, seed dispersal, insect outbreak, disease propagation, forest harvest, and fuel treatment, because controlled field experiments designed to study the effects of these processes are often not possible (...

Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

Directory of Open Access Journals (Sweden)

Achilles Ploumidis

2013-01-01

Full Text Available Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome is the complication mostly feared from large renal angiomyolipomas (RAMLs. In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

Forward treatment planning techniques to reduce the normalization effect in Gamma Knife radiosurgery.

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Cheng, Hao-Wen; Lo, Wei-Lun; Kuo, Chun-Yuan; Su, Yu-Kai; Tsai, Jo-Ting; Lin, Jia-Wei; Wang, Yu-Jen; Pan, David Hung-Chi

2017-11-01

In Gamma Knife forward treatment planning, normalization effect may be observed when multiple shots are used for treating large lesions. This effect can reduce the proportion of coverage of high-value isodose lines within targets. The aim of this study was to evaluate the performance of forward treatment planning techniques using the Leksell Gamma Knife for the normalization effect reduction. We adjusted the shot positions and weightings to optimize the dose distribution and reduce the overlap of high-value isodose lines from each shot, thereby mitigating the normalization effect during treatment planning. The new collimation system, Leksell Gamma Knife Perfexion, which contains eight movable sectors, provides an additional means to reduce the normalization effect by using composite shots. We propose different techniques in forward treatment planning that can reduce the normalization effect. Reducing the normalization effect increases the coverage proportion of higher isodose lines within targets, making the high-dose region within targets more uniform and increasing the mean dose to targets. Because of the increase in the mean dose to the target after reducing the normalization effect, we can set the prescribed marginal dose at a higher isodose level and reduce the maximum dose, thereby lowering the risk of complications. © 2017 Shuang Ho Hospital-Taipei Medical University. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Describing treatment effects to patients.

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Moxey, Annette; O'Connell, Dianne; McGettigan, Patricia; Henry, David

2003-11-01

To examine the impact of different presentations of equivalent information (framing) on treatment decisions faced by patients. A systematic review of the published literature was conducted. English language publications allocating participants to different frames were retrieved using electronic and bibliographic searches. Two reviewers examined each article for inclusion, and assessed methodological quality. Study characteristics were tabulated and where possible, relative risks (RR; 95% confidence intervals) were calculated to estimate intervention effects. Thirty-seven articles, yielding 40 experimental studies, were included. Studies examined treatment (N = 24), immunization (N = 5), or health behavior scenarios (N = 11). Overall, active treatments were preferred when outcomes were described in terms of relative rather than absolute risk reductions or number needed to treat. Surgery was preferred to other treatments when treatment efficacy was presented in a positive frame (survival) rather than a negative frame (mortality) (relative risk [RR] = 1.51, 95% confidence interval [CI], 1.39 to 1.64). Framing effects were less obvious for immunization and health behavior scenarios. Those with little interest in the behavior at baseline were influenced by framing, particularly when information was presented as gains. In studies judged to be of good methodological quality and/or examining actual decisions, the framing effect, although still evident, was less convincing compared to the results of all included studies. Framing effects varied with the type of scenario, responder characteristics, scenario manipulations, and study quality. When describing treatment effects to patients, expressing the information in more than one way may present a balanced view to patients and enable them to make informed decisions.

Sclerotherapy for large hydrocoeles in Nigeria.

Science.gov (United States)

Onu, P E

2000-07-01

Sclerotherapy with tetracycline hydrochloride was used to treat 99 patients with large hydrocoeles (range 300-1500 ml). The mean age of these patients was 52 years. In 55.5% of the patients one treatment was adequate. Two treatments were required in 22%; three in 10%; four in 3%; and five in 7% of the patients. In two patients sclerotherapy failed. Complications were minimal. Only 15% of the patients complained of severe pain. The overall success rate was 98%. Tetracycline sclerotherapy for large hydrocoeles is effective, safe and economical and is preferred for older patients who are at risk from anaesthetic complications.

Treatment selection in a randomized clinical trial via covariate-specific treatment effect curves.

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Ma, Yunbei; Zhou, Xiao-Hua

2017-02-01

For time-to-event data in a randomized clinical trial, we proposed two new methods for selecting an optimal treatment for a patient based on the covariate-specific treatment effect curve, which is used to represent the clinical utility of a predictive biomarker. To select an optimal treatment for a patient with a specific biomarker value, we proposed pointwise confidence intervals for each covariate-specific treatment effect curve and the difference between covariate-specific treatment effect curves of two treatments. Furthermore, to select an optimal treatment for a future biomarker-defined subpopulation of patients, we proposed confidence bands for each covariate-specific treatment effect curve and the difference between each pair of covariate-specific treatment effect curve over a fixed interval of biomarker values. We constructed the confidence bands based on a resampling technique. We also conducted simulation studies to evaluate finite-sample properties of the proposed estimation methods. Finally, we illustrated the application of the proposed method in a real-world data set.

Treatment time reduction for large thermal lesions by using a multiple 1D ultrasound phased array system

International Nuclear Information System (INIS)

Liu, H.-L.; Chen, Y.-Y.; Yen, J.-Y.; Lin, W.-L.

2003-01-01

To generate large thermal lesions in ultrasound thermal therapy, cooling intermissions are usually introduced during the treatment to prevent near-field heating, which leads to a long treatment time. A possible strategy to shorten the total treatment time is to eliminate the cooling intermissions. In this study, the two methods, power optimization and acoustic window enlargement, for reducing power accumulation in the near field are combined to investigate the feasibility of continuously heating a large target region (maximally 3.2 x 3.2 x 3.2 cm 3 ). A multiple 1D ultrasound phased array system generates the foci to scan the target region. Simulations show that the target region can be successfully heated without cooling and no near-field heating occurs. Moreover, due to the fact that there is no cooling time during the heating sessions, the total treatment time is significantly reduced to only several minutes, compared to the existing several hours

Neuropsychological profile and clinical effects of arginine treatment in children with creatine transport deficiency

Science.gov (United States)

2012-01-01

Background SLC6A8, an X-linked gene, encodes the creatine transporter (CRTR) and its mutations lead to cerebral creatine (Cr) deficiency which results in mental retardation, speech and language delay, autistic-like behaviour and epilepsy (CRTR-D, OMIM 300352). CRTR-D represents the most frequent Cr metabolism disorder but, differently from Cr synthesis defects, that are partially reversible by oral Cr supplementation, does not respond to Cr treatment even if precociously administrated. The precursors of Cr are the non-essential amino acids Glycine (Gly) and Arginine (Arg), which have their own transporters at the brain–blood barrier level and, therefore, their supplementation appears an attractive and feasible therapeutic option aimed at stimulating Cr endogenous synthesis and, in this way, at overcoming the block of Cr transport within the brain. However, until now the effects of Arg and/or Gly supplementation on Cr brain levels and behaviour have been controversial. Methods In this study five Italian male patients affected by CRTR-D were supplemented with oral L-Arg at a dosage of 300 mg/kg/day divided into 3 doses, for 24–36 months. Biochemical and plasmatic amino acids examinations and thyroid hormone dosages were periodically performed. Moreover, Proton and Phosphorus Magnetic Resonance Spectroscopy (MRS) was monitored during follow-up in concurrence with neuropsychological evaluations. Results During L-Arg treatment a clinical improvement in motor skills and to a lesser extent in communication and attention was observed. In addition, all patients had a reduction in the number and frequency of epileptic seizures. Daily living skills appeared also to be positively influenced by L-Arg treatment. Moreover, Total Cr and especially PhosphoCr, evaluated by proton and phosphorus spectroscopy, showed a mild increase, although well below the normal range. Conclusion This study provides information to support the effectiveness of L-Arg supplement treatment in

Management of side effects during and post-treatment in breast cancer survivors.

Science.gov (United States)

Palesh, Oxana; Scheiber, Caroline; Kesler, Shelli; Mustian, Karen; Koopman, Cheryl; Schapira, Lidia

2018-03-01

Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are commonly experienced symptoms that share psychological and physical manifestations. One or more of these symptoms will affect nearly all patients at some point during their course of treatment or survivorship. These side effects are burdensome and reduce patients' quality of life well beyond their cancer diagnosis and associated care treatments. Cancer-related fatigue, insomnia, and cancer-related cognitive impairment are likely to have multiple etiologies that make it difficult to identify the most effective method to manage them. In this review, we summarized the information on cancer-related fatigue, insomnia, and cancer-related cognitive impairment incidence and prevalence among breast cancer patients and survivors as well as recent research findings on pharmaceutical, psychological, and exercise interventions that have shown effectiveness in the treatment of these side effects. Our review revealed that most current pharmaceutical interventions tend to ameliorate symptoms only temporarily without addressing the underlying causes. Exercise and behavioral interventions are consistently more effective at managing chronic symptoms and possibly address an underlying etiology. Future research is needed to investigate effective interventions that can be delivered directly in clinic to a large portion of patients and survivors. © 2017 Wiley Periodicals, Inc.

Spatiotemporal Fractionation Schemes for Irradiating Large Cerebral Arteriovenous Malformations

Energy Technology Data Exchange (ETDEWEB)

Unkelbach, Jan, E-mail: junkelbach@mgh.harvard.edu [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Bussière, Marc R. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Chapman, Paul H. [Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Loeffler, Jay S.; Shih, Helen A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

2016-07-01

Purpose: To optimally exploit fractionation effects in the context of radiosurgery treatments of large cerebral arteriovenous malformations (AVMs). In current practice, fractionated treatments divide the dose evenly into several fractions, which generally leads to low obliteration rates. In this work, we investigate the potential benefit of delivering distinct dose distributions in different fractions. Methods and Materials: Five patients with large cerebral AVMs were reviewed and replanned for intensity modulated arc therapy delivered with conventional photon beams. Treatment plans allowing for different dose distributions in all fractions were obtained by performing treatment plan optimization based on the cumulative biologically effective dose delivered at the end of treatment. Results: We show that distinct treatment plans can be designed for different fractions, such that high single-fraction doses are delivered to complementary parts of the AVM. All plans create a similar dose bath in the surrounding normal brain and thereby exploit the fractionation effect. This partial hypofractionation in the AVM along with fractionation in normal brain achieves a net improvement of the therapeutic ratio. We show that a biological dose reduction of approximately 10% in the healthy brain can be achieved compared with reference treatment schedules that deliver the same dose distribution in all fractions. Conclusions: Boosting complementary parts of the target volume in different fractions may provide a therapeutic advantage in fractionated radiosurgery treatments of large cerebral AVMs. The strategy allows for a mean dose reduction in normal brain that may be valuable for a patient population with an otherwise normal life expectancy.

Effectiveness of medical treatment for Cushing's syndrome: a systematic review and meta-analysis.

Science.gov (United States)

Broersen, Leonie H A; Jha, Meghna; Biermasz, Nienke R; Pereira, Alberto M; Dekkers, Olaf M

2018-05-31

To systematically review the effectiveness of medical treatment for Cushing's syndrome in clinical practice, regarding cortisol secretion, clinical symptom improvement, and quality of life. To assess the occurrence of side effects of these medical therapies. Eight electronic databases were searched in March 2017 to identify potentially relevant articles. Randomized controlled trials and cohort studies assessing the effectiveness of medical treatment in patients with Cushing's syndrome, were eligible. Pooled proportions were reported including 95% confidence intervals. We included 35 articles with in total 1520 patients in this meta-analysis. Most included patients had Cushing's disease. Pooled reported percentage of patients with normalization of cortisol ranged from 35.7% for cabergoline to 81.8% for mitotane in Cushing's disease. Patients using medication monotherapy showed a lower percentage of cortisol normalization compared to use of multiple medical agents (49.4 vs. 65.7%); this was even higher for patients with concurrent or previous radiotherapy (83.6%). Mild side effects were reported in 39.9%, and severe side effects were seen in 15.2% of patients after medical treatment. No meta-analyses were performed for clinical symptom improvement or quality of life due to lack of sufficient data. This meta-analysis shows that medication induces cortisol normalization effectively in a large percentage of patients. Medical treatment for Cushing's disease patients is thus a reasonable option in case of a contraindication for surgery, a recurrence, or in patients choosing not to have surgery. When experiencing side effects or no treatment effect, an alternate medical therapy or combination therapy can be considered.

Treatment of large posttraumatic tibial bone defects using the Ilizarov method: a subjective outcome assessment.

Science.gov (United States)

Krappinger, Dietmar; Irenberger, Alexander; Zegg, Michael; Huber, Burkhart

2013-06-01

The treatment of large posttraumatic tibial bone defects using the Ilizarov method was shown to be successful in several studies. These studies, however, typically focus on the radiological and functional outcome using objective parameters only. The aim of the present study was therefore to assess the objective and subjective outcome of a consecutive series of patients with large posttraumatic tibial bone defects using the Ilizarov method. Additionally, it was our goal to assess the physical and mental stress for the patients and their relatives during the long treatment period and the general health status at final follow-up. A consecutive series of 15 patients with posttraumatic tibial bone defects of >30 mm after sustaining open tibial fractures and failure of internal fixation was included. The objective outcome was assessed at final follow-up using Paley's criteria. For the assessment of the subjective outcome, all patients were asked to evaluate their satisfaction with the function of the lower leg, the cosmetic appearance and overall outcome as well. The physical and mental stress of the treatment for the patients and the nearest relative of patients were assessed at the time of frame removal using a custom-made questionnaire. The SF-36 was used to evaluate the general health status at final follow-up. Solid bone union with stable soft tissue coverage and eradication of infection was achieved in all patients despite a high complication rate. The functional outcome at final follow-up was excellent or good in all patients. The patients' satisfaction with the overall outcome and the function of the lower extremity was high as well. The fear of amputation and complications was the major subjective burden for both the patients and their relatives. The long external fixation time is another relevant issue. The Ilizarov method is a safe option for the treatment of large posttraumatic tibial bone defects after failure of internal fixation despite the high

Effectiveness of a Barge-Based Ballast Water Treatment System for Multi-Terminal Ports

Directory of Open Access Journals (Sweden)

Lovro Maglić

2015-10-01

Full Text Available The paper presents outcomes of the discrete event simulation of the ballast water management in a multi-terminal port. The simulation includes ship’s manoeuvring, cargo and ballast operations and a barge-based ballast water treatment system operating within all terminal areas. The barge-based ballast water treatment system is used by ships unable to use their own equipment, not equipped with an appropriate ballast treatment system or non-compliant with the Ballast Water Management (BWM Convention 2004 for whatever reason. The main goal is to estimate the productivity and cost effectiveness of such systems as an option to support ships not able to comply with the BWM Convention, once it enters into force. The model was built and tested in Arena simulation software. Process parameters are based on real traffic data for the port of Rijeka. The results indicate that barge-based ballast treatment facility will be heavily underutilized, and that such systems are cost-effective only in ports where large volumes of ballast water need to be delivered to shore treatment systems.

Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility

Energy Technology Data Exchange (ETDEWEB)

LeBlance, R.J.; Allain, C.J.; Laughton, P.J.; Henry, J.G.

2003-07-01

The Greater Moncton Sewerage Commission's 115 000 m{sup 3}/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Universite de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and ''cumulative effects'' as part of the overall biosolids management strategy is also discussed. (author)

Understanding placebo, nocebo, and iatrogenic treatment effects.

Science.gov (United States)

Bootzin, Richard R; Bailey, Elaine T

2005-07-01

Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self-focused attention to symptoms, motivation to change, and sociocultural role-enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo.

Percutaneous ethanol injection of large autonomous hyperfunctioning thyroid nodules.

Science.gov (United States)

Tarantino, L; Giorgio, A; Mariniello, N; de Stefano, G; Perrotta, A; Aloisio, V; Tamasi, S; Forestieri, M C; Esposito, F; Esposito, F; Finizia, L; Voza, A

2000-01-01

To verify the effectiveness of percutaneous ethanol injection (PEI) in the treatment of large (>30-mL) hyperfunctioning thyroid nodules. Twelve patients (eight women, four men; age range, 26-76 years) with a large hyperfunctioning thyroid nodule (volume range, 33-90 mL; mean, 46.08 mL) underwent PEI treatment under ultrasonographic (US) guidance. US was used to calculate the volume of the nodules and to assess the diffusion of the ethanol in the lesions during the procedure. When incomplete necrosis of the nodule was depicted at scintigraphy performed 3 months after treatment, additional PEI sessions were performed. Four to 11 PEI sessions (mean, seven) were performed in each patient, with an injection of 3-14 mL of 99.8% ethanol per session (total amount of ethanol per patient, 30-108 mL; mean, 48.5 mL). At scintigraphy after treatment in all patients, recovery of extranodular uptake, absence of uptake in the nodule, and normalization of thyroid-stimulating hormone (thyrotropin) levels were observed. In all patients, US showed volume reductions of 30%-50% after 3 months and 40%-80% after 6-9 months. Side effects were self-limiting in all patients. During the 6-48-month follow-up, no recurrence was observed. PEI is an effective and safe technique for the treatment of large hyperfunctioning thyroid nodules.

Breast Cancer: Treatment, Outcomes, and Cost-Effectiveness

National Research Council Canada - National Science Library

McClellan, Mark

2000-01-01

...) use Medicare data, linked SEER cancer registry data, and claims data from large firms to analyze trends in diagnosis rates and staging, treatment, expenditures, and outcomes for Americans with breast cancer; and (3...

Nonparametric Bounds and Sensitivity Analysis of Treatment Effects

Science.gov (United States)

Richardson, Amy; Hudgens, Michael G.; Gilbert, Peter B.; Fine, Jason P.

2015-01-01

This paper considers conducting inference about the effect of a treatment (or exposure) on an outcome of interest. In the ideal setting where treatment is assigned randomly, under certain assumptions the treatment effect is identifiable from the observable data and inference is straightforward. However, in other settings such as observational studies or randomized trials with noncompliance, the treatment effect is no longer identifiable without relying on untestable assumptions. Nonetheless, the observable data often do provide some information about the effect of treatment, that is, the parameter of interest is partially identifiable. Two approaches are often employed in this setting: (i) bounds are derived for the treatment effect under minimal assumptions, or (ii) additional untestable assumptions are invoked that render the treatment effect identifiable and then sensitivity analysis is conducted to assess how inference about the treatment effect changes as the untestable assumptions are varied. Approaches (i) and (ii) are considered in various settings, including assessing principal strata effects, direct and indirect effects and effects of time-varying exposures. Methods for drawing formal inference about partially identified parameters are also discussed. PMID:25663743

Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment

Science.gov (United States)

Balevi, Mustafa

2017-01-01

Objective: The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). Materials and Methods: We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Results: Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Conclusion

Prospective and Retrospective Studies of Substance Abuse Treatment Outcomes: Methods and Results of Four Large-Scale Follow-Up Studies.

Science.gov (United States)

Gerstein, Dean R.; Johnson, Robert A.

This report compares the research methods, provider and patient characteristics, and outcome results from four large-scale followup studies of drug treatment during the 1990s: (1) the California Drug and Alcohol Treatment Assessment (CALDATA); (2) Services Research Outcomes Study (SROS); (3) National Treatment Improvement Evaluation Study (NTIES);…

Prostate cancer outcomes in France: treatments, adverse effects and two-year mortality

Science.gov (United States)

2014-01-01

Background This very large population-based study investigated outcomes after a diagnosis of prostate cancer (PCa) in terms of mortality rates, treatments and adverse effects. Methods Among the 11 million men aged 40 years and over covered by the general national health insurance scheme, those with newly managed PCa in 2009 were followed for two years based on data from the national health insurance information system (SNIIRAM). Patients were identified using hospitalisation diagnoses and specific refunds related to PCa and PCa treatments. Adverse effects of PCa treatments were identified by using hospital diagnoses, specific procedures and drug refunds. Results The age-standardised two-year all-cause mortality rate among the 43,460 men included in the study was 8.4%, twice that of all men aged 40 years and over. Among the 36,734 two-year survivors, 38% had undergone prostatectomy, 36% had been treated by hormone therapy, 29% by radiotherapy, 3% by brachytherapy and 20% were not treated. The frequency of treatment-related adverse effects varied according to age and type of treatment. Among men between 50 and 69 years of age treated by prostatectomy alone, 61% were treated for erectile dysfunction and 24% were treated for urinary disorders. The frequency of treatment for these disorders decreased during the second year compared to the first year (erectile dysfunction: 41% vs 53%, urinary disorders: 9% vs 20%). The frequencies of these treatments among men treated by external beam radiotherapy alone were 7% and 14%, respectively. Among men between 50 and 69 years with treated PCa, 46% received treatments for erectile dysfunction and 22% for urinary disorders. For controls without PCa but treated surgically for benign prostatic hyperplasia, these frequencies were 1.5% and 6.0%, respectively. Conclusions We report high survival rates two years after a diagnosis of PCa, but a high frequency of PCa treatment-related adverse effects. These frequencies remain

Clinical risk factors for weight gain during psychopharmacologic treatment of depression: results from 2 large German observational studies.

Science.gov (United States)

Kloiber, Stefan; Domschke, Katharina; Ising, Marcus; Arolt, Volker; Baune, Bernhard T; Holsboer, Florian; Lucae, Susanne

2015-06-01

Weight gain during psychopharmacologic treatment has considerable impact on the clinical management of depression, treatment continuation, and risk for metabolic disorders. As no profound clinical risk factors have been identified so far, the aim of our analyses was to determine clinical risk factors associated with short-term weight development in 2 large observational psychopharmacologic treatment studies for major depression. Clinical variables at baseline (age, gender, depression psychopathology, anthropometry, disease history, and disease entity) were analyzed for association with percent change in body mass index (BMI; normal range, 18.5 to 25 kg/m(2)) during 5 weeks of naturalistic psychopharmacologic treatment in patients who had a depressive episode as single depressive episode, in the course of recurrent unipolar depression or bipolar disorder according to DSM-IV criteria. 703 patients participated in the Munich Antidepressant Response Signature (MARS) project, an ongoing study since 2002, and 214 patients participated in a study conducted at the University of Muenster from 2004 to 2006 in Germany. Lower BMI, weight-increasing side effects of medication, severity of depression, and psychotic symptoms could be identified as clinical risk factors associated with elevated weight gain during the initial treatment phase of 5 weeks in both studies. Based on these results, a composite risk score for weight gain consisting of BMI ≤ 25 kg/m(2), Hamilton Depression Rating Scale (17-item) score > 20, presence of psychotic symptoms, and administration of psychopharmacologic medication with potential weight-gaining side effects was highly discriminative for mean weight gain (F4,909 = 26.77, P = 5.14E-21) during short-term psychopharmacologic treatment. On the basis of our results, depressed patients with low to normal BMI, severe depression, or psychotic symptoms should be considered at higher risk for weight gain during acute antidepressant treatment. We introduce

Effects of plasma treatment on wounds

NARCIS (Netherlands)

Tipa, R.S.; Stoffels - Adamowicz, E.; Lim, C.T.; Goh, J.C.H.

2009-01-01

Cold plasma treatment of wounds is gaining much interest, because it will offer a non-contact, painless and harmless therapy to manage large-area lesions (burn wounds, chronic ulcerations). One of the important issues in plasma wound healing is the safety of the method. In this work we study in

Quantitative Missense Variant Effect Prediction Using Large-Scale Mutagenesis Data.

Science.gov (United States)

Gray, Vanessa E; Hause, Ronald J; Luebeck, Jens; Shendure, Jay; Fowler, Douglas M

2018-01-24

Large datasets describing the quantitative effects of mutations on protein function are becoming increasingly available. Here, we leverage these datasets to develop Envision, which predicts the magnitude of a missense variant's molecular effect. Envision combines 21,026 variant effect measurements from nine large-scale experimental mutagenesis datasets, a hitherto untapped training resource, with a supervised, stochastic gradient boosting learning algorithm. Envision outperforms other missense variant effect predictors both on large-scale mutagenesis data and on an independent test dataset comprising 2,312 TP53 variants whose effects were measured using a low-throughput approach. This dataset was never used for hyperparameter tuning or model training and thus serves as an independent validation set. Envision prediction accuracy is also more consistent across amino acids than other predictors. Finally, we demonstrate that Envision's performance improves as more large-scale mutagenesis data are incorporated. We precompute Envision predictions for every possible single amino acid variant in human, mouse, frog, zebrafish, fruit fly, worm, and yeast proteomes (https://envision.gs.washington.edu/). Copyright © 2017 Elsevier Inc. All rights reserved.

RETROPERITONEAL LAPAROSCOPIC TREATMENT OF LARGE ...

African Journals Online (AJOL)

Conclusion Retroperitoneal laparoscopic ureterolithotomy is a good minimally invasive alternative line of treatment for ureteral stones in cases not amenable for ESWL or endoscopy. However, it takes a long learning curve. Moreover, a careful case selection and good working instruments are necessary for success.

Condutivity effect in electro-coagulation-flotation applied to physico-chemical wastewater treatment

OpenAIRE

Francisco Javier Cuba Terán; Mário Luiz Rodrigues Foco

2007-01-01

This study reports on the effect of conductivity on the simultaneous applicability of water electrolysis , chemical coagulation and flotation fundamentals in the treatment of wastewater with large amounts of suspended matter, characterizing electro-coagulation-flotation (ECF) . Results from experiments carried out in a pilot study implanted and operated in the Laboratory of Environment Control (LCA), at the State University of Campinas in Limeira are presented. ECF was developed in an electro...

Renal effects of long-term ciclosporin A treatment in a large animal model

DEFF Research Database (Denmark)

Cibulskyte, Donata; Samsoe Engberg, Anne; Hanefelt Kristensen, Daniel

2007-01-01

BACKGROUND: Most experimental studies of chronic ciclosporin A (CsA) nephrotoxicity have been performed in rodents; however, the pig possesses several advantages. The aim of this study was to investigate renal functional and structural changes during CsA treatment with 20 mg/kg/day for 6 months i...

Effects of combustible stacking in large compartments

DEFF Research Database (Denmark)

Gentili, Filippo; Giuliani, Luisa; Bontempi, Franco

2013-01-01

This paper focuses on the modelling of fire in case of various distributions of combustible materials in a large compartment. Large compartments often represent a challenge for structural fire safety, because of lack of prescriptive rules to follow and difficulties of taking into account the effect...... of non uniform distribution of the combustible materials and fire propagation. These aspects are discussed in this paper with reference to an industrial steel building, taken as case study. Fires triggered by the burning of wooden pallets stored in the premises have been investigated with respect...

Differential effectiveness of placebo treatments

DEFF Research Database (Denmark)

Meissner, Karin; Fässler, Margrit; Rücker, Gerta

2013-01-01

IMPORTANCE When analyzing results of randomized clinical trials, the treatment with the greatest specific effect compared with its placebo control is considered to be the most effective one. Although systematic variations of improvements in placebo control groups would have important implications...... relevant sources through February 2012 and contacted the authors to identify randomized clinical trials on the prophylaxis of migraine with an observation period of at least 8 weeks after randomization that compared an experimental treatment with a placebo control group. We calculated pooled random-effects...... and sham surgery are associated with higher responder ratios than oral pharmacological placebos. Clinicians who treat patients with migraine should be aware that a relevant part of the overall effect they observe in practice might be due to nonspecific effects and that the size of such effects might differ...

Delayed conifer mortality after fuel reduction treatments: Interactive effects of fuel, fire intensity, and bark beetles

Science.gov (United States)

Youngblood, A.; Grace, J.B.; Mciver, J.D.

2009-01-01

Many low-elevation dry forests of the western United States contain more small trees and fewer large trees, more down woody debris, and less diverse and vigorous understory plant communities compared to conditions under historical fire regimes. These altered structural conditions may contribute to increased probability of unnaturally severe wildfires, susceptibility to uncharacteristic insect outbreaks, and drought-related mortality. Broad-scale fuel reduction and restoration treatments are proposed to promote stand development on trajectories toward more sustainable structures. Little research to date, however, has quantified the effects of these treatments on the ecosystem, especially delayed and latent tree mortality resulting directly or indirectly from treatments. In this paper, we explore complex hypotheses relating to the cascade of effects that influence ponderosa pine (Pinus ponderosa) and Douglas-fir (Pseudotsuga menziesii) mortality using structural equation modeling (SEM). We used annual census and plot data through six growing seasons after thinning and four growing seasons after burning from a replicated, operational-scale, completely randomized experiment conducted in northeastern Oregon, USA, as part of the national Fire and Fire Surrogate study. Treatments included thin, burn, thin followed by burn (thin+burn), and control. Burn and thin+burn treatments increased the proportion of dead trees while the proportion of dead trees declined or remained constant in thin and control units, although the density of dead trees was essentially unchanged with treatment. Most of the new mortality (96%) occurred within two years of treatment and was attributed to bark beetles. Bark beetle-caused tree mortality, while low overall, was greatest in thin + burn treatments. SEM results indicate that the probability of mortality of large-diameter ponderosa pine from bark beetles and wood borers was directly related to surface fire severity and bole charring, which in

Effectiveness of propanolol for treatment of infantile haemangioma

DEFF Research Database (Denmark)

Andersen, Ida Gillberg; Rechnitzer, Catherine; Charabi, Birgitte

2014-01-01

INTRODUCTION: Infantile haemangiomas (IH) are the most common benign tumours in children. They are characterised by rapid growth during the first year of life followed by spontaneous regression during childhood. Indications for treatment are functional impairment, bleeding/ulceration, rapid growth...... and severe aesthetic risk. Recently, systemic treatment with propranolol has become the first-line therapy. The objective of this study was to assess the efficacy of propranolol in the treatment of IH and to investigate whether treatment with a low dose of 1 mg/kg/day was sufficient. MATERIAL AND METHODS...... large residual changes. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

The effect of heat treatment on phosphorus segregation in a submerged-arc weld metal

International Nuclear Information System (INIS)

Beere, W.B.; Buswell, J.T.

1999-01-01

Intergranular fracture (IGF) has been observed in carbon-manganese steels after irradiation or high temperature exposure for prolonged periods. The effect is associated with an increase in the ductile-brittle transition temperature and has been related to phosphorus diffusion to grain boundaries. Phosphorus also diffuses thermally at the temperatures used for post-weld heat treatments such that in principle, the slightly different heat treatments given to different parts of a large vessel could lead to differing grain boundary phosphorus coverage and hence susceptibility to IGF. The effect of typical heat treatments on phosphorus coverage has been investigated using a finite difference model based on a theory that has been fitted to a wide range of constant temperature data. Regardless of previous history, the grain boundary coverage of phosphorus was predicted to depend on the final anneal and cooling rate. These differed insufficiently in the typical heat treatments to produce significant differences in segregation. It was concluded that the ductile-brittle transition temperature in submerged-arc welds would be unaffected in vessels that had seen typical post-weld heat treatments

40 CFR 141.81 - Applicability of corrosion control treatment steps to small, medium-size and large water systems.

Science.gov (United States)

2010-07-01

... treatment steps to small, medium-size and large water systems. 141.81 Section 141.81 Protection of... WATER REGULATIONS Control of Lead and Copper § 141.81 Applicability of corrosion control treatment steps...). (ii) A report explaining the test methods used by the water system to evaluate the corrosion control...

Imiquimod 5% cream for the treatment of large nodular basal cell carcinoma at the medial canthal area

Directory of Open Access Journals (Sweden)

Gamze Ozturk Karabulut

2017-01-01

Full Text Available Context (Background: Imiquimod (IMQ 5% cream is an immunomodulatory and antitumorigenic agent, which was used as a topical treatment regimen, who had periocular basal cell carcinoma (BCC. Aim: This study aims to present three cases with large BCC at the medial canthal area treated with IMQ 5% cream. Materials and Methods: IMQ 5% cream was used in three patients with ages 45, 49, and 73 who preferred medical treatment over surgery. Following incisional biopsy IMQ cream was used once a day, 5 times a week and the patients were followed up weekly during 12 week treatment period and monthly after the clearance of the lesion. Results: Erythema and erosion on the surface of the lesion, injection of conjunctiva, burning and itching sensation, epiphora and punctate keratitis were seen in all patients during the treatment period. The ophthalmic side effects could be managed by topical lubricating eye drops and the inflammatory reactions resolved within 1 month after cessation of therapy. The patients were followed up for at least 3 years without tumor recurrence and the biopsies taken from the suspected area were found to be tumor free. Conclusion: Surgical excision of carcinoma of the eyelid at medial canthal area can be difficult without causing damage to the lacrimal system and reconstruction of the defect may need grafts or flaps. IMQ may provide an alternative therapy to surgery in certain cases.

Treatment effectiveness and fidelity of manual therapy to the knee: A systematic review and meta-analysis.

Science.gov (United States)

Salamh, Paul; Cook, Chad; Reiman, Michael P; Sheets, Charles

2017-09-01

Manual therapy (MT) is a commonly used treatment for knee osteoarthritis (OA) but to date only one systematic review has explored its effectiveness. The purpos e of the present study was to perform a systematic review and meta-analysis of the literature, to determine the effectiveness and fidelity of studies using MT techniques in individuals with knee OA. Relevant studies were assessed for inclusion. Effectiveness was measured using effect sizes, and methodological bias and treatment fidelity were both explored. Effect sizes were calculated using standardized mean differences (SMD) based on pooled data depending on statistical and clinical heterogeneity, as well as risk of bias. The search captured 2,969 studies; after screening, 12 were included. Four had a low risk of bias and high treatment fidelity. For self-reported function, comparing MT with no treatment resulted in a large effect size (standardized mean difference [SMD] 0.84), as did adding MT to a comparator treatment (SMD 0.78). A significant difference was found for pain when adding MT to a comparator treatment (SMD 0.73). The findings in the present meta-analytical review support the use of MT versus a number of different comparators for improvement in self-reported knee function. Lesser support is present for pain reduction, and no endorsement of functional performance can be made at this time. Copyright © 2016 John Wiley & Sons, Ltd.

Laparoscopic transperitoneal ureterolithotomy for large ureteric stones

Directory of Open Access Journals (Sweden)

Ahmed Al-Sayyad

2012-01-01

Conclusion: Laparoscopic transperitoneal ureterolithotomy is a safe and effective approach for selected patients with large proximal ureteric stones with reduced postoperative pain and short hospital stay, and should be considered as a treatment option for such stones.

Surgical-prosthetic treatment of large mandibular cysts

Directory of Open Access Journals (Sweden)

Džambas Ljubiša D.

2003-01-01

Full Text Available This paper presents a combined surgical-prosthetic procedure of reconstructing mandibular bone defect in a 53 year old patient, following enucleation of a mandibular cyst (Cystectomy Partsch II. After a thorough diagnostic evaluation, a surgical procedure was planned with the particular attention to the nature of the disease, patient’s condition, size and extension of the cyst, tissue loss, and the possibilities of prosthetic management of a mandibular bone defect with partial postresection dental prosthesis. It is of great importance to point to the significance of teamwork of a maxillofacial surgeon and a specialist in prosthodontics. This kind of cooperation provided very effective and less risky soft tissue, as well as bone tissue regeneration (osteogenesis. The patient’s recovery was fast, and he could return to his daily activities and work without significant changes regarding quality of life after surgery and prosthetic treatment.

Visual Analytics of Complex Genomics Data to Guide Effective Treatment Decisions

Directory of Open Access Journals (Sweden)

Quang Vinh Nguyen

2016-09-01

Full Text Available In cancer biology, genomics represents a big data problem that needs accurate visual data processing and analytics. The human genome is very complex with thousands of genes that contain the information about the individual patients and the biological mechanisms of their disease. Therefore, when building a framework for personalised treatment, the complexity of the genome must be captured in meaningful and actionable ways. This paper presents a novel visual analytics framework that enables effective analysis of large and complex genomics data. By providing interactive visualisations from the overview of the entire patient cohort to the detail view of individual genes, our work potentially guides effective treatment decisions for childhood cancer patients. The framework consists of multiple components enabling the complete analytics supporting personalised medicines, including similarity space construction, automated analysis, visualisation, gene-to-gene comparison and user-centric interaction and exploration based on feature selection. In addition to the traditional way to visualise data, we utilise the Unity3D platform for developing a smooth and interactive visual presentation of the information. This aims to provide better rendering, image quality, ergonomics and user experience to non-specialists or young users who are familiar with 3D gaming environments and interfaces. We illustrate the effectiveness of our approach through case studies with datasets from childhood cancers, B-cell Acute Lymphoblastic Leukaemia (ALL and Rhabdomyosarcoma (RMS patients, on how to guide the effective treatment decision in the cohort.

Coping with Cosmetic Effects of Cancer Treatment

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... Search English Español Coping With Cosmetic Effects of Cancer Treatment KidsHealth / For Parents / Coping With Cosmetic Effects of Cancer Treatment What's in this article? Hair Loss Skin Problems ...

Racial differences in treatment and survival in older patients with diffuse large B-cell lymphoma (DLBCL)

International Nuclear Information System (INIS)

Griffiths, Robert; Gleeson, Michelle; Knopf, Kevin; Danese, Mark

2010-01-01

Diffuse large B-cell lymphoma (DLBCL) comprises 31% of lymphomas in the United States. Although it is an aggressive type of lymphoma, 40% to 50% of patients are cured with treatment. The study objectives were to identify patient factors associated with treatment and survival in DLBCL. Using Surveillance, Epidemiology, and End Results (SEER) registry data linked to Medicare claims, we identified 7,048 patients diagnosed with DLBCL between January 1, 2001 and December 31, 2005. Patients were followed from diagnosis until the end of their claims history (maximum December 31, 2007) or death. Medicare claims were used to characterize the first infused chemo-immunotherapy (C-I therapy) regimen and to identify radiation. Multivariate analyses were performed to identify patient demographic, socioeconomic, and clinical factors associated with treatment and with survival. Outcomes variables in the survival analysis were all-cause mortality, non-Hodgkin's lymphoma (NHL) mortality, and other/unknown cause mortality. Overall, 84% (n = 5,887) received C-I therapy or radiation treatment during the observation period: both, 26%; C-I therapy alone, 53%; and radiation alone, 5%. Median age at diagnosis was 77 years, 54% were female, 88% were white, and 43% had Stage III or IV disease at diagnosis. The median time to first treatment was 42 days, and 92% of these patients had received their first treatment by day 180 following diagnosis. In multivariate analysis, the treatment rate was significantly lower among patients ≥ 80 years old, blacks versus whites, those living in a census tract with ≥ 12% poverty, and extra-nodal disease. Blacks had a lower treatment rate overall (Hazard Ratio [HR] 0.77; P < 0.001), and were less likely to receive treatment within 180 days of diagnosis (Odds Ratio [OR] 0.63; P = 0.002) than whites. In multivariate survival analysis, black race was associated with higher all-cause mortality (HR 1.24; P = 0.01) and other/unknown cause mortality (HR 1

Short-term nanostructural effects of high radiofrequency treatment on the skin tissues of rabbits.

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Choi, Samjin; Cheong, Youjin; Shin, Jae-Ho; Lee, Hui-Jae; Lee, Gi-Ja; Choi, Seok Keun; Jin, Kyung-Hyun; Park, Hun-Kuk

2012-09-01

The aim of this study is to quantitatively investigate the short-term effects of RF tissue-tightening treatment in in vivo rabbit dermal collagen fibrils. These effects were measured at different energy levels and at varying pass procedures on the nanostructural response level using histology and AFM analysis. Each rabbit was divided into one of seven experimental groups, which included the following: control group, and six RF group according to RF energy (20 W and 40 W) and three RF pass procedures. The progressive changes in the diameter and D-periodicity of rabbit dermal collagen fibrils were investigated in detail over a 7-day post-treatment period. The dermal tissues treated with the RF tissue-tightening device showed more prominent inflammatory responses with inflammatory cell ingrowth compared to the control. This effect showed more prominent with the passage of day after treatment. Although an increase in the diameter and D-periodicity of dermal collagen fibrils was identified immediately after the RF treatment, a decrease in the morphology of dermal collagen fibrils continued until post-operative day 7. Furthermore, RF treatment led to the loss of distinct borders. Increases in RF energy with the same pass procedure, as well as an increase in the number of RF passes, increased the occurrence of irreversible collagen fibril injury. A multiple-pass treatment at low energy rather than a single-pass treatment at high energy showed a large amount of collagen fibrils contraction at the nanostructural level.

Cost-effectiveness of root caries preventive treatments.

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Schwendicke, Falk; Göstemeyer, Gerd

2017-01-01

With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments. Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed. In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option. Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations. Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of sleep management with self-help treatment for the Japanese elderly with chronic insomnia: a quasi-experimental study.

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Tamura, Norihisa; Tanaka, Hideki

2017-08-01

This study aimed to determine whether sleep management with self-help treatment is more effective in improving insomnia, compared to a waiting-list control. A total of 51 participants with insomnia, aged ≥60 years, were assigned to two groups: the treatment group or waiting-list control group. Intervention included sleep education, group work, moderately intense exercise, and self-help treatment using a sleep diary for 2 weeks. Participants completed the Insomnia Severity Index (ISI-J) and sleep diaries wearing an activity recorder pre- and post-treatment. The treatment group showed a significant improvement in the ISI-J with a fairly large effect size (Cohen's d: within = 0.78, between = 0.70), whereas the waiting-list control group did not. Sleep diary and activity recorder data showed small to moderate effect sizes in the treatment group. Thus, sleep management with self-help treatment was superior to a waiting-list control for insomnia severity in the targeted elderly population.

Fertility effects of cancer treatment.

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Marsden, Donald E; Hacker, Neville

2003-01-01

Cancer sufferers are a subfertile group, and most treatments have the potential to adversely affect gonadal function. As cancer treatment becomes more effective and survival rates improve there are more cancer survivors in the reproductive age group for whom parenting is an important consideration. This article outlines the effects on fertility of cancer treatments and techniques to minimise the risk of infertility. The overall prospects for younger cancer sufferers to either retain their fertility or have genetic offspring is now better than ever before, due to advances in assisted reproductive technology, the appropriate use of fertility sparing surgery and other techniques to reduce the toxicity of therapy on the reproductive organs. These advances raise new moral and ethical concerns that must be considered before advising cancer sufferers of the options for preserving reproductive capacity.

Effect of fibre treatment using fluorosilane on Sansevieria Trifasciata/Polypropylene composite

Science.gov (United States)

Aref, Yanzur Mohd; Baharum, Azizah

2018-04-01

Recently, there is an increasing interest in the development of wood-plastic composites (WPC) due to their advantages such as wide availability, low cost, environment friendliness and sustainability. However, some major factors limiting the large scales production of WPC including the tendency of natural fibres to absorb water and the poor compatibility between fibre and matrix. In this study, we investigated the effectiveness of natural fibre treatment using fluorosilane in imparting hydrophobicity to the polypropylene (PP) matrix composite reinforced with Sansevieria Trifasciata (ST) fibres. ST fibres are subjected to silane treatment with 1H,1H,2H,2H-perfluorooctyltriethoxsysilane (POTS) at 1, 3 and 5% for a period of 2 hours. Influence of POTS treatment on the physical and mechanical properties of composites was studied to determine the optimum condition of silane treatment. The water contact angle (WCA) of WPC increased after POTS treatment where the highest value of 115° was shown by 3% POTS treated ST/PP composite. Based on mechanical properties results, incorporation of POTS treated ST fibre improves the mechanical properties with the enhancement of flexural and impact strength. The treatment with 3% POTS revealed statistically higher flexural strength and modulus compared to 1 and 5%. The water absorption test of ST/PP composites also gives the best result for 3% POTS treatment with 20.90% water uptake.

Effectiveness of propanolol for treatment of infantile haemangioma

DEFF Research Database (Denmark)

Andersen, Ida Gillberg; Rechnitzer, Catherine; Charabi, Birgitte

2014-01-01

: This study was retrospective and based on a review of children treated for IH with propranolol from the 2010-2012 period at Rigshospitalet. RESULTS: Overall, propranolol was effective in all but one child (97%). The majority of the children (84%) were treated with an initial dose of 1 mg/kg/day, which...... was considered sufficient in most cases (71%). Children who started treatment before five months of age had a significantly better response than children who started treatment at a later age. No relation was found between location of IH and the effect of treatment. There were only few and mild side effects....... CONCLUSION: Propranolol is effective in the treatment of IH and it has only few and mild side effects. In most cases, a low dose of 1 mg/kg/day was sufficient. Early initiation of treatment is recommended as the response to treatment was better in younger children and because early initiation helps prevent...

Effectiveness of an Internet-based preparation for psychosomatic treatment: Results of a controlled observational study.

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Zimmer, Benjamin; Moessner, Markus; Wolf, Markus; Minarik, Carla; Kindermann, Sally; Bauer, Stephanie

2015-11-01

Patients often have to sustain long waiting periods between the time they first apply for psychotherapy and the actual uptake of the treatment. To support patients who are on a wait-list for inpatient psychosomatic treatment an Internet-based preparatory treatment (VORSTAT) was developed. In a randomized controlled trial, VORSTAT proved to increase treatment motivation prior to intake and to accelerate the accommodation phase at the beginning of inpatient treatment. No impact of VORSTAT on inpatient treatment outcome was found. The aim of the present study was to investigate the effectiveness of VORSTAT after implementing the service into routine care. A large naturalistic observational study comparing VORSTAT participants (N=911) against non-participants (N=1721) was conducted. Propensity scores were used to control for potential confounding variables due to the non-randomized group allocation. Reliable improvement of self-reported impairment achieved during inpatient treatment was used as outcome measure. VORSTAT participants showed higher rates of reliable improvement in physical impairment (50.8% vs. 44.9%), psychological impairment (41.2% vs. 29.9%), and social problems (22.3% vs. 15.2%). An Internet-based preparation for psychotherapy is an effective approach to improve outcome of inpatient psychosomatic treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

Nucleoli in large (giant bi- and multinucleate cells after apoptosis-inducing photodynamic treatment

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K Smetana

2009-06-01

Full Text Available The present experimental study was undertaken to provide information on nucleolar changes accompanying the apoptotic process in large or giant binucleate and multinucleate cells (LBMNCs. Such cells were present in a small but constant percentage in cultures of HL-60 cells. The apoptotic process was induced by photodynamic treatment (PDT by means of 5-aminolaevulinic acid (ALA as the precursor of the photosensitizer protoporphyrin IX and irradiation with broad spectrum blue light (BL. Nucleolar changes in LBMNCs were characterized by marked reduction or disappearance of silver stained particles representing AgNORs in nucleoli including the large ones. In addition, PDT also significantly reduced the number of nucleoli regardless of their size. These changes apparently reflected the decrease or cessation of nucleolar biosynthetic activities and resembled those which were previously observed in naturally maturing bone marrow megakaryocytes (Janoutová et al., 2001.

Complete remission in a colon cancer patient with a large, irresectable liver metastasis after XELOX/cetuximab/bevacizumab treatment.

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Weihrauch, Martin R; Stippel, Dirk; Fries, Jochen W U; Arnold, Dirk; Bovenschulte, Henning; Coutelle, Oliver; Hacker, Ulrich

2008-09-01

Stage IV colorectal cancer is usually an incurable disease. However, patients with resectable metastases have 5-year disease-free survival rates of up to 30%. Even with primarily irresectable disease, cure can be achieved in patients who become operable after neoadjuvant treatment. To improve the prognosis of these patients, highly effective neoadjuvant regimens need to be developed. Here, we report the case of a 62-year-old male patient who had been diagnosed with International Union against Cancer (UICC) stage III colon cancer 7 years previously and now presented with a large, irresectable liver metastasis and enlarged perihepatic lymph nodes. After neoadjuvant treatment with cetuximab, bevacizumab and XELOX, the patient showed a complete remission and underwent surgery. Histopathologically, the resected tissue and lymph nodes were free of residual tumor. To our knowledge, this is the first report of a complete pathological response in a patient with irresectable colorectal cancer after intensive chemotherapy/anti-EGFR/ VEGF antibody therapy. This combination regimen may help to improve the survival rates for patients with irresectable disease. Copyright 2008 S. Karger AG, Basel.

Treatment of hepatocellular carcinoma adjacent to large blood vessels using 1.5T MRI-guided percutaneous radiofrequency ablation combined with iodine-125 radioactive seed implantation

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Lin, Zheng-Yu, E-mail: linsinlan@yahoo.com.cn [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); Chen, Jin, E-mail: snow8968851@163.com [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China); Deng, Xiu-Fen, E-mail: dxf197286@yahoo.com.cn [The Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005 (China)

2012-11-15

Objective: The objective is to study the technology associated with and feasibility of the treatment of hepatocellular carcinoma (HCC) adjacent to large blood vessels using 1.5T MRI-guided radiofrequency ablation combined with iodine-125 (I-125) radioactive seed implantation. Methods: Sixteen patients with a total of 24 HCC lesions (average maximum diameter: 2.35 {+-} 1.03 cm) were pathologically confirmed by biopsy or clinically diagnosed received 1.5T MRI-guided percutaneous radiofrequency ablation (RFA) treatment. Each patient had one lesion adjacent to large blood vessels ({>=}3 mm); after the ablation, I-125 radioactive seeds were implanted in the portions of the lesions that were adjacent to the blood vessels. Results: All the ablations and I-125 radioactive seed implantations were successful; a total of 118 seeds were implanted. The ablated lesions exhibited hypointense signals on the T2WI sequence with a thin rim of hyperintense signals; they also exhibited significant hyperintense signals on the T1WI sequence with clear boundaries. The average follow-up period was 11.1 {+-} 6.2 months. There were 23 complete responses and one partial response in the 24 lesions. The alpha-fetoprotein (AFP) levels of the patients significantly decreased. Conclusion: The 1.5T MRI-guided RFA combined with I-125 radioactive seed implantation for the treatment of HCC adjacent to large blood vessels is an effective technology.

Effect of chronic treatment with a cyclooxygenase inhibitor on reproductive parameters in male rat

International Nuclear Information System (INIS)

Saeed, S.A.; Anwar, N.; Khan, K.M.; Sarfraz, N.

2009-01-01

Indomethacin is a member of non-steroidal anti-inflammatory drugs (NSAIDs) commonly used for treatment of gout, arthritis, and other inflammatory conditions. It has been shown to inhibit ovarian prostaglandins synthesis in mammals, birds, fish and reptiles. However, the effects of its chronic administration on male reproductive functions remain largely unknown. Using rat as a model, we studied the effect of chronic treatment with indomethacin on the male reproductive system. Methods: Testosterone was measured in the serum, testicular tissue, and testicular interstitial fluid by radioimmunoassay. Moreover, we also studied the direct effect of indomethacin in vitro on luteinizing hormone stimulated testosterone secretion from the Leydig cells isolated from various treatment groups. Results: Indomethacin treatment for 50 days caused a significant but reversible decrease in prostate weight, epididymal sperm reserves and sperm motility score compared with control rats (p<0.05). In vitro stimulation of Leydig cells isolated from treated rat's testes with luteinizing hormone (250 mu IU) produced significantly reduced testosterone compared with cells from control groups (p<0.05). Furthermore, stimulatory effect of luteinizing hormone on the control Leydig cells was significantly reduced when these cells were challenged with luteinizing hormone in the presence of indomethacin, (p<0.05). Testosterone concentration in the testicular tissue and testicular interstitial fluid reduced after indomethacin treatment (p<0.05). Conclusion: Due to its significant inhibition of key reproductive hormones, indomethacin effectively inhibits reproductive functions if used on a long-term basis. In his study, we have identified potential risks in the long-term use of cyclooxygenase inhibitors. (author)

Post-treatment surveillance in a large cohort of patients with colon cancer.

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Hu, Chung-Yuan; Delclos, George L; Chan, Wenyaw; Du, Xianglin L

2011-05-01

To determine how patients complied with different components of guideline-recommended post-treatment surveillance in a large nationwide population-based cohort of patients with colon cancer. Retrospective cohort study. We used the linked Surveillance, Epidemiology, and End Results-Medicare database to identify patients 66 years or older diagnosed as having stage I to stage III colon adenocarcinoma between January 2000 and June 2002 with a follow-up duration of at least 3.5 years. After tumor resection, patients who completed at least 2 office visits per year for 3 years, at least 2 carcinoembryonic antigen tests per year (in the first and second years of follow-up), and at least 1 colonoscopy within 3 years were defined as meeting the recommended post-treatment care. We identified 7348 patients, with a median follow-up duration of 59 months. Adherence to post-treatment surveillance was 83.9% for office visits, 29.4% for carcinoembryonic antigen tests, and 74.3% for colonoscopy. Younger age at diagnosis, white race/ethnicity, married status, advanced tumor stage, fewer comorbidities, and chemotherapy use were significantly associated with guideline adherence. Adherence to colon cancer posttreatment surveillance was low, although proportions of patients complying with office visits and colonoscopy were reasonably high. Underlying reasons for noncompliance, which varied by type of service, may need further investigation.

Optimal counterterrorism and the recruitment effect of large terrorist attacks

DEFF Research Database (Denmark)

Jensen, Thomas

2011-01-01

We analyze a simple dynamic model of the interaction between terrorists and authorities. Our primary aim is to study optimal counterterrorism and its consequences when large terrorist attacks lead to a temporary increase in terrorist recruitment. First, we show that an increase in counterterrorism...... makes it more likely that terrorist cells plan small rather than large attacks and therefore may increase the probability of a successful attack. Analyzing optimal counterterrorism we see that the recruitment effect makes authorities increase the level of counterterrorism after large attacks. Therefore......, in periods following large attacks a new attack is more likely to be small compared to other periods. Finally, we analyze the long-run consequences of the recruitment effect. We show that it leads to more counterterrorism, more small attacks, and a higher sum of terrorism damage and counterterrorism costs...

Laser treatment in patients with bilateral large drusen: the complications of age-related macular degeneration prevention trial.

Science.gov (United States)

2006-11-01

To evaluate the efficacy and safety of low-intensity laser treatment in the prevention of visual acuity (VA) loss among participants with bilateral large drusen. Multicenter randomized clinical trial. One eye of each participant was assigned to treatment, and the contralateral eye was assigned to observation. A total of 1052 participants who had > or =10 large (>125 microm) drusen and VA> or =20/40 in each eye enrolled through 22 clinical centers. The initial laser treatment protocol specified 60 barely visible burns applied in a grid pattern within an annulus between 1500 and 2500 mum from the foveal center. At 12 months, eyes assigned to treatment that had sufficient drusen remaining were retreated with 30 burns by targeting drusen within an annulus between 1000 and 2000 mum from the foveal center. Proportion of eyes at 5 years with loss of > or =3 lines of VA from baseline. Secondary outcome measures included the development of choroidal neovascularization or geographic atrophy (GA), change in contrast threshold, change in critical print size, and incidence of ocular adverse events. At 5 years, 188 (20.5%) treated eyes and 188 (20.5%) observed eyes had VA scores > or = 3 lines worse than at the initial visit (P = 1.00). Cumulative 5-year incidence rates for treated and observed eyes were 13.3% and 13.3% (P = 0.95) for choroidal neovascularization and 7.4% and 7.8% (P = 0.64) for GA, respectively. The contrast threshold doubled in 23.9% of treated eyes and in 20.5% of observed eyes (P = 0.40). The critical print size doubled in 29.6% of treated eyes and in 28.4% of observed eyes (P = 0.70). Seven treated eyes and 14 observed eyes had an adverse event of a > or =6-line loss in VA in the absence of late age-related macular degeneration or cataract. As applied in the Complications of Age-Related Macular Degeneration Prevention Trial, low-intensity laser treatment did not demonstrate a clinically significant benefit for vision in eyes of people with bilateral large

Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence.

Science.gov (United States)

Hague, Ben; Hall, Jo; Kellett, Stephen

2016-09-01

Background and aims This review appraises the progression and status of the evidence base for the treatment of compulsive buying disorder (CBD), in order to highlight what currently works and to prompt useful future research. Methods Online databases ISI Web of Knowledge, PsycINFO, and PubMed via Ovid were searched at two time points. Two quality checklists and an established model of therapy evaluation (hourglass model) evaluated the quality and progression of both psychotherapy and pharmacotherapy treatments for CBD. Uncontrolled effect sizes were calculated and meta-regression analyses were performed regarding treatment duration. Results A total of 29 articles met the inclusion criteria, which were divided into psychotherapy (n = 17) and pharmacotherapy treatments (n = 12). Of the 29 studies, only 5 studies have been tested under conditions of high methodological quality. Both forms of treatment had been evaluated in a haphazard manner across the stages of the hourglass model. Although large effects were demonstrated for group psychotherapy and pharmacotherapy, such evidence of effectiveness was undermined by poor study quality and risk of publication bias. Long-term CBD treatment was associated with improved outcome with pharmacotherapy, but not when delivering psychotherapy. Discussion Group psychotherapy currently appears the most promising treatment option for CBD. Poor methodological control and sporadic evaluation of specific treatments have slowed the generation of a convincing evidence base for CBD treatment. Defining the active ingredients of effective CBD treatment is a key research goal.

Lessons learned in the conduct of a global, large simple trial of treatments indicated for schizophrenia.

Science.gov (United States)

Kolitsopoulos, Francesca M; Strom, Brian L; Faich, Gerald; Eng, Sybil M; Kane, John M; Reynolds, Robert F

2013-03-01

Large, "practical" or streamlined trials (LSTs) are used to study the effectiveness and/or safety of medicines in real world settings with minimal study imposed interventions. While LSTs have benefits over traditional randomized clinical trials and observational studies, there are inherent challenges to their conduct. Enrollment and follow-up of a large study sample of patients with mental illness pose a particular difficulty. To assist in overcoming operational barriers in future LSTs in psychiatry, this paper describes the recruitment and observational follow-up strategies used for the ZODIAC study, an international, open-label LST, which followed 18,239 persons randomly assigned to one of two treatments indicated for schizophrenia for 1 year. ZODIAC enrolled patients in 18 countries in North America, South America, Europe, and Asia using broad study entry criteria and required minimal clinical care intervention. Recruitment of adequate numbers and continued engagement of both study centers and subjects were significant challenges. Strategies implemented to mitigate these in ZODIAC include global study expansion, study branding, field coordinator and site relations programs, monthly site newsletters, collection of alternate contact information, conduct of national death index (NDI) searches, and frequent sponsor, contract research organization (CRO) and site interaction to share best practices and address recruitment challenges quickly. We conclude that conduct of large LSTs in psychiatric patient populations is feasible, but importantly, realistic site recruitment goals and maintaining site engagement are key factors that need to be considered in early study planning and conduct. Copyright © 2012 Elsevier Inc. All rights reserved.

Treatment of neuroblastoma with metaiodobenzylguanidine: results and side effects

International Nuclear Information System (INIS)

Treuner, J.; Klingebiel, T.; Bruchelt, G.; Feine, U.; Niethammer, D.

1987-01-01

Between April 1984 and December 1985 we treated ten children suffering from neuroblastoma in a total of 25 metaiodobenzylguanidine (MIBG) courses. Five had had a relapse of neuroblastoma stage III or IV, three had never achieved a remission in spite of intensive chemotherapy, and two were treated with an unstable remission. The children were each administered from 1 to 5 courses with a dosage per course of between 1295 and 9065 MBq. The sum of the single doses during the whole course of therapy ranged between 3145 and 21,904 MBq per child. Five of five children suffering from bone pain and fever became free of complaints during the first three treatment days. Six of eight children with manifest tumor at onset of therapy responded well to the treatment: response extended from transitory decrease in elevated catecholamine levels in serum and urine to complete disappearance of large abdominal tumor masses. We also observed a decrease in bone marrow involvement and a stabilization of osteolytic lesions. Seven of these eight children died in spite of a good response from 55 to 350 days after the first MIBG treatment course. The only side effect we witnessed was a reversible bone marrow depression. In three children we combined the MIBG therapy with bone marrow transplantation

Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain.

Science.gov (United States)

Turk, Dennis C

2002-01-01

Chronic pain is a prevalent and costly problem. This review addresses the question of the clinical effectiveness and cost-effectiveness of the most common treatments for patients with chronic pain. Representative published studies that evaluate the clinical effectiveness of pharmacological treatments, conservative (standard) care, surgery, spinal cord stimulators, implantable drug delivery systems (IDDSs), and pain rehabilitation programs (PRPs) are examined and compared. The cost-effectiveness of these treatment approaches is also considered. Outcome criteria including pain reduction, medication use, health care consumption, functional activities, and closure of disability compensation cases are examined. In addition to clinical effectiveness, the cost-effectiveness of PRPs, conservative care, surgery, spinal cord stimulators, and IDDSs are compared using costs to return a treated patient to work to illustrate the relative expenses for each of these treatments. There are limitations to the success of all the available treatments. The author urges caution in interpreting the results, particularly in comparisons between treatments and across studies, because there are broad differences in the pain syndromes and inclusion criteria used, the drug dosages, comparability of treatments, the definition of "chronic" used, the outcome criteria selected to determine success, and societal differences. None of the currently available treatments eliminates pain for the majority of patients. Pain rehabilitation programs provide comparable reduction in pain to alternative pain treatment modalities, but with significantly better outcomes for medication use, health care utilization, functional activities, return to work, closure of disability claims, and with substantially fewer iatrogenic consequences and adverse events. Surgery, spinal cord stimulators, and IDDSs appear to have substantial benefits on some outcome criteria for carefully selected patients. These modalities are

What Is the Optimal Treatment of Large Brain Metastases? An Argument for a Multidisciplinary Approach

International Nuclear Information System (INIS)

Choi, Clara Y.H.; Chang, Steven D.; Gibbs, Iris C.; Adler, John R.; Harsh, Griffith R.; Atalar, Banu; Lieberson, Robert E.; Soltys, Scott G.

2012-01-01

Purpose: Single-modality treatment of large brain metastases (>2 cm) with whole-brain irradiation, stereotactic radiosurgery (SRS) alone, or surgery alone is not effective, with local failure (LF) rates of 50% to 90%. Our goal was to improve local control (LC) by using multimodality therapy of surgery and adjuvant SRS targeting the resection cavity. Patients and Methods: We retrospectively evaluated 97 patients with brain metastases >2 cm in diameter treated with surgery and cavity SRS. Local and distant brain failure (DF) rates were analyzed with competing risk analysis, with death as a competing risk. The overall survival rate was calculated by the Kaplain-Meier product-limit method. Results: The median imaging follow-up duration for all patients was 10 months (range, 1–80 months). The 12-month cumulative incidence rates of LF, with death as a competing risk, were 9.3% (95% confidence interval [CI], 4.5%–16.1%), and the median time to LF was 6 months (range, 3–17 months). The 12-month cumulative incidence rate of DF, with death as a competing risk, was 53% (95% CI, 43%–63%). The median survival time for all patients was 15.6 months. The median survival times for recursive partitioning analysis classes 1, 2, and 3 were 33.8, 13.7, and 9.0 months, respectively (p = 0.022). On multivariate analysis, Karnofsky Performance Status (≥80 vs. <80; hazard ratio 0.54; 95% CI 0.31–0.94; p = 0.029) and maximum preoperative tumor diameter (hazard ratio 1.41; 95% CI 1.08–1.85; p = 0.013) were associated with survival. Five patients (5%) required intervention for Common Terminology Criteria for Adverse Events v4.02 grade 2 and 3 toxicity. Conclusion: Surgery and adjuvant resection cavity SRS yields excellent LC of large brain metastases. Compared with other multimodality treatment options, this approach allows patients to avoid or delay whole-brain irradiation without compromising LC.

Small Versus Large-Sized Drug-Eluting Beads (DEBIRI) for the Treatment of Hepatic Colorectal Metastases: A Propensity Score Matching Analysis

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Akinwande, Olaguoke K., E-mail: gokeakin@gmail.com [University of Louisville Hospital, Department of Interventional Radiology (United States); Philips, Prejesh, E-mail: prejesh.philips@louisville.edu [University of Louisville, Division of Surgical Oncology, Department of Surgery (United States); Duras, Petr, E-mail: durasp@seznam.cz [Fakultní nemocnice Plzeň (Czech Republic); Pluntke, Stefan, E-mail: stefan.pluntke@t-online.de [Onkologe bei Kliniken Essen-Mitte (Germany); Scoggins, Charles, E-mail: charles.scoggins@louisville.edu; Martin, Robert C. G., E-mail: Robert.Martin@louisville.edu [University of Louisville, Division of Surgical Oncology, Department of Surgery (United States)

2015-04-15

PurposeTo compare the feasibility, safety, and efficacy with small and large irinotecan drug-eluting beads (DEBIRI) for treating hepatic colorectal metastases.MethodsUsing our prospectively maintained, multi-center, intra-arterial therapy registry, we identified 196 patients treated with a combination of large beads (100–300 to 500–700 μm) and patients treated with a combination of small beads (70–150 to 100–300 μm). To minimize selection bias, a propensity score analysis was performed to compare both groups.ResultsUnadjusted analysis consisted of 196 and 30 patients treated with large and small beads, respectively. The adjusted analysis consisted of 19 patients each. Unadjusted analysis showed decreased all-grade (p = <0.001) and high-grade adverse effects (p = 0.02) in the small bead group, with a persisting trend toward decreased overall side effects in the adjusted analysis favoring small beads (p = 0.09) The adjusted analysis showed the percentage dose delivered (delivered dose/intended dose) was significantly greater in the small bead group compared to the large bead group (96 vs 79 %; p = 0.005). There were also a lower percentage of treatments terminating in complete stasis in the adjusted analysis (0.0035). Adjusted analysis also showed increased objective response rate (ORR) at 12 months (p = 0.04), with a corresponding trend also seen in the unadjusted analysis (0.09).ConclusionSmaller beads result in increased dose delivery probably due to less propensity to reach complete stasis. It may also lead to more durable long-term efficacy. Smaller beads also demonstrate similarly low toxicity compared to large-sized beads with a trend toward less toxicity.

Small Versus Large-Sized Drug-Eluting Beads (DEBIRI) for the Treatment of Hepatic Colorectal Metastases: A Propensity Score Matching Analysis

International Nuclear Information System (INIS)

Akinwande, Olaguoke K.; Philips, Prejesh; Duras, Petr; Pluntke, Stefan; Scoggins, Charles; Martin, Robert C. G.

2015-01-01

PurposeTo compare the feasibility, safety, and efficacy with small and large irinotecan drug-eluting beads (DEBIRI) for treating hepatic colorectal metastases.MethodsUsing our prospectively maintained, multi-center, intra-arterial therapy registry, we identified 196 patients treated with a combination of large beads (100–300 to 500–700 μm) and patients treated with a combination of small beads (70–150 to 100–300 μm). To minimize selection bias, a propensity score analysis was performed to compare both groups.ResultsUnadjusted analysis consisted of 196 and 30 patients treated with large and small beads, respectively. The adjusted analysis consisted of 19 patients each. Unadjusted analysis showed decreased all-grade (p = <0.001) and high-grade adverse effects (p = 0.02) in the small bead group, with a persisting trend toward decreased overall side effects in the adjusted analysis favoring small beads (p = 0.09) The adjusted analysis showed the percentage dose delivered (delivered dose/intended dose) was significantly greater in the small bead group compared to the large bead group (96 vs 79 %; p = 0.005). There were also a lower percentage of treatments terminating in complete stasis in the adjusted analysis (0.0035). Adjusted analysis also showed increased objective response rate (ORR) at 12 months (p = 0.04), with a corresponding trend also seen in the unadjusted analysis (0.09).ConclusionSmaller beads result in increased dose delivery probably due to less propensity to reach complete stasis. It may also lead to more durable long-term efficacy. Smaller beads also demonstrate similarly low toxicity compared to large-sized beads with a trend toward less toxicity

The effects of large beach debris on nesting sea turtles

Science.gov (United States)

Fujisaki, Ikuko; Lamont, Margaret M.

2016-01-01

A field experiment was conducted to understand the effects of large beach debris on sea turtle nesting behavior as well as the effectiveness of large debris removal for habitat restoration. Large natural and anthropogenic debris were removed from one of three sections of a sea turtle nesting beach and distributions of nests and false crawls (non-nesting crawls) in pre- (2011–2012) and post- (2013–2014) removal years in the three sections were compared. The number of nests increased 200% and the number of false crawls increased 55% in the experimental section, whereas a corresponding increase in number of nests and false crawls was not observed in the other two sections where debris removal was not conducted. The proportion of nest and false crawl abundance in all three beach sections was significantly different between pre- and post-removal years. The nesting success, the percent of successful nests in total nesting attempts (number of nests + false crawls), also increased from 24% to 38%; however the magnitude of the increase was comparably small because both the number of nests and false crawls increased, and thus the proportion of the nesting success in the experimental beach in pre- and post-removal years was not significantly different. The substantial increase in sea turtle nesting activities after the removal of large debris indicates that large debris may have an adverse impact on sea turtle nesting behavior. Removal of large debris could be an effective restoration strategy to improve sea turtle nesting.

The effective field theory of cosmological large scale structures

Energy Technology Data Exchange (ETDEWEB)

Carrasco, John Joseph M. [Stanford Univ., Stanford, CA (United States); Hertzberg, Mark P. [Stanford Univ., Stanford, CA (United States); SLAC National Accelerator Lab., Menlo Park, CA (United States); Senatore, Leonardo [Stanford Univ., Stanford, CA (United States); SLAC National Accelerator Lab., Menlo Park, CA (United States)

2012-09-20

Large scale structure surveys will likely become the next leading cosmological probe. In our universe, matter perturbations are large on short distances and small at long scales, i.e. strongly coupled in the UV and weakly coupled in the IR. To make precise analytical predictions on large scales, we develop an effective field theory formulated in terms of an IR effective fluid characterized by several parameters, such as speed of sound and viscosity. These parameters, determined by the UV physics described by the Boltzmann equation, are measured from N-body simulations. We find that the speed of sound of the effective fluid is c²_s ≈ 10^–6c² and that the viscosity contributions are of the same order. The fluid describes all the relevant physics at long scales k and permits a manifestly convergent perturbative expansion in the size of the matter perturbations δ(k) for all the observables. As an example, we calculate the correction to the power spectrum at order δ(k)⁴. As a result, the predictions of the effective field theory are found to be in much better agreement with observation than standard cosmological perturbation theory, already reaching percent precision at this order up to a relatively short scale k ≃ 0.24h Mpc^–1.

Study on brain hemodynamics function according to data of rheoencephalography during multimodality treatment of oncologic patients with the use of general controlled artificial hyperthermia with hyperglycemia or with large insulin doses

International Nuclear Information System (INIS)

Lysenko, E.V.

1990-01-01

For the first time the effect of single and multiple treatments of artificial hyperthermia (AHT) with hyperglycemia (HG) or with large insulin doses on cerebral circulation of oncologic patients is studied. Cerebral hemodynamics was studied by rheoencephalography. The conclusion is made about the unidirectional AHT effect regardless of the bacrground used. 5 refs.; 4 tabs

Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial

Science.gov (United States)

Forestier, R; Desfour, H; Tessier, J-M; Françon, A; Foote, A M; Genty, C; Rolland, C; Roques, C-F; Bosson, J-L

2010-01-01

Objective To determine whether spa therapy, plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment, in the management of knee osteoarthritis. Methods Large multicentre randomised prospective clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria, attending French spa resorts as outpatients between June 2006 and April 2007. Zelen randomisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating. The main endpoint criteria were patient self-assessed. All patients continued usual treatments and performed daily standardised home exercises. The spa therapy group also received 18 days of spa therapy (massages, showers, mud and pool sessions). Main Endpoint The number of patients achieving minimal clinically important improvement (MCII) at 6 months, defined as ≥19.9 mm on the visual analogue pain scale and/or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery. Results The intention to treat analysis included 187 controls and 195 spa therapy patients. At 6 months, 99/195 (50.8%) spa group patients had MCII and 68/187 (36.4%) controls (χ2=8.05; df=1; p=0.005). However, no improvement in quality of life (Short Form 36) or patient acceptable symptom state was observed at 6 months. Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone, and is well tolerated. Trial registration number NCT00348777. PMID:19734131

Implant-retained skull prosthesis to cover a large defect of the hairy skull resulting from treatment of a basal cell carcinoma : A clinical report

NARCIS (Netherlands)

Hoekstra, Jitske; Vissink, Arjan; Raghoebar, Gerry M; Visser, Anita

Skin carcinoma, particularly basal cell carcinoma, and its treatment can result in large defects of the hairy skull. A 53-year-old man is described who was surgically treated for a large basal cell carcinoma invading the skin and underlying tissue at the top of the hairy skull. Treatment consisted

Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation.

Science.gov (United States)

Beitel, Mark; Oberleitner, Lindsay; Muthulingam, Dharushana; Oberleitner, David; Madden, Lynn M; Marcus, Ruthanne; Eller, Anthony; Bono, Madeline H; Barry, Declan T

2018-03-09

Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap. Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory. Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision). Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.

Effects of large-scale deforestation on precipitation in the monsoon regions: remote versus local effects.

Science.gov (United States)

Devaraju, N; Bala, Govindasamy; Modak, Angshuman

2015-03-17

In this paper, using idealized climate model simulations, we investigate the biogeophysical effects of large-scale deforestation on monsoon regions. We find that the remote forcing from large-scale deforestation in the northern middle and high latitudes shifts the Intertropical Convergence Zone southward. This results in a significant decrease in precipitation in the Northern Hemisphere monsoon regions (East Asia, North America, North Africa, and South Asia) and moderate precipitation increases in the Southern Hemisphere monsoon regions (South Africa, South America, and Australia). The magnitude of the monsoonal precipitation changes depends on the location of deforestation, with remote effects showing a larger influence than local effects. The South Asian Monsoon region is affected the most, with 18% decline in precipitation over India. Our results indicate that any comprehensive assessment of afforestation/reforestation as climate change mitigation strategies should carefully evaluate the remote effects on monsoonal precipitation alongside the large local impacts on temperatures.

Do drug treatment facilities increase clients' exposure to potential neighborhood-level triggers for relapse? A small-area assessment of a large, public treatment system.

Science.gov (United States)

Jacobson, Jerry O

2006-03-01

Research on drug treatment facility locations has focused narrowly on the issue of geographic proximity to clients. We argue that neighborhood conditions should also enter into the facility location decision and illustrate a formal assessment of neighborhood conditions at facilities in a large, metropolitan area, taking into account conditions clients already face at home. We discuss choice and construction of small-area measures relevant to the drug treatment context, including drug activity, disadvantage, and violence as well as statistical comparisons of clients' home and treatment locations with respect to these measures. Analysis of 22,707 clients discharged from 494 community-based outpatient and residential treatment facilities that received public funds during 1998-2000 in Los Angeles County revealed no significant mean differences between home and treatment neighborhoods. However, up to 20% of clients are exposed to markedly higher levels of disadvantage, violence, or drug activity where they attend treatment than where they live, suggesting that it is not uncommon for treatment locations to increase clients' exposure to potential environmental triggers for relapse. Whereas on average both home and treatment locations exhibit higher levels of these measures than the household locations of the general population, substantial variability in public treatment clients' home neighborhoods calls into question the notion that they hail exclusively from poor, high drug activity areas. Shortcomings of measures available for neighborhood assessment of treatment locations and implications of the findings for other areas of treatment research are also discussed.

Large-scale automatic extraction of side effects associated with targeted anticancer drugs from full-text oncological articles.

Science.gov (United States)

Xu, Rong; Wang, QuanQiu

2015-06-01

Targeted anticancer drugs such as imatinib, trastuzumab and erlotinib dramatically improved treatment outcomes in cancer patients, however, these innovative agents are often associated with unexpected side effects. The pathophysiological mechanisms underlying these side effects are not well understood. The availability of a comprehensive knowledge base of side effects associated with targeted anticancer drugs has the potential to illuminate complex pathways underlying toxicities induced by these innovative drugs. While side effect association knowledge for targeted drugs exists in multiple heterogeneous data sources, published full-text oncological articles represent an important source of pivotal, investigational, and even failed trials in a variety of patient populations. In this study, we present an automatic process to extract targeted anticancer drug-associated side effects (drug-SE pairs) from a large number of high profile full-text oncological articles. We downloaded 13,855 full-text articles from the Journal of Oncology (JCO) published between 1983 and 2013. We developed text classification, relationship extraction, signaling filtering, and signal prioritization algorithms to extract drug-SE pairs from downloaded articles. We extracted a total of 26,264 drug-SE pairs with an average precision of 0.405, a recall of 0.899, and an F1 score of 0.465. We show that side effect knowledge from JCO articles is largely complementary to that from the US Food and Drug Administration (FDA) drug labels. Through integrative correlation analysis, we show that targeted drug-associated side effects positively correlate with their gene targets and disease indications. In conclusion, this unique database that we built from a large number of high-profile oncological articles could facilitate the development of computational models to understand toxic effects associated with targeted anticancer drugs. Copyright © 2015 Elsevier Inc. All rights reserved.

Effective string dynamics in large N QCD

Energy Technology Data Exchange (ETDEWEB)

Iroshnikov, G.S. [Centro Brasileiro de Pesquisas Fisicas (CBPF), Rio de Janeiro, RJ (Brazil)]|[Moskow Inst. of Physics and Technology, Moscow (Russian Federation)

1995-05-01

The semiclassical 1/N expansion in the strong coupling regime for spinor quarks was developed and the form of effective action was obtained. An extremum of the effective action that arises in the calculation of the hadronic correlation functions in the large N limit corresponds to a topologically non-trivial configuration of the gauge field. This configuration forms a chromoelectric Nambu string with additional spinor terms that contain in particular the Polyakov spinor factor. In the case when real quarks forming hadrons are replaced by scalar particles the above correlators yield the standard dual resonance amplitudes. (author). 10 refs, 1 fig.

SU-F-T-538: CyberKnife with MLC for Treatment of Large Volume Tumors: A Feasibility Study

Energy Technology Data Exchange (ETDEWEB)

Bichay, T; Mayville, A [Mercy Health, Saint Mary’s, Grand Rapids, MI (United States)

2016-06-15

Purpose: CyberKnife is a well-documented modality for SRS and SBRT treatments. Typical tumors are small and 1–5 fractions are usually used. We determined the feasibility of using CyberKnife, with an InCise multileaf collimator option, for larger tumors undergoing standard dose and fractionation. The intent was to understand the limitation of using this modality for other external beam radiation treatments. Methods: Five tumors from different anatomical sites with volumes from 127.8 cc to 1,320.5 cc were contoured and planned on a Multiplan V5.1 workstation. The target average diameter ranged from 7 cm to 13 cm. The dose fractionation was 1.8–2.0 Gy/fraction and 25–45 fractions for total doses of 45–81 Gy. The sites planned were: pancreas, head and neck, prostate, anal, and esophagus. The plans were optimized to meet conventional dose constraints based on various RTOG protocols for conventional fractionation. Results: The Multiplan treatment planning system successfully generated clinically acceptable plans for all sites studied. The resulting dose distributions achieved reasonable target coverage, all greater than 95%, and satisfactory normal tissue sparing. Treatment times ranged from 9 minutes to 38 minutes, the longest being a head and neck plan with dual targets receiving different doses and with multiple adjacent critical structures. Conclusion: CyberKnife, with the InCise multileaf collimation option, can achieve acceptable dose distributions in large volume tumors treated with conventional dose and fractionation. Although treatment times are greater than conventional accelerator time; target coverage and dose to critical structures can be kept within a clinically acceptable range. While time limitations exist, when necessary CyberKnife can provide an alternative to traditional treatment modalities for large volume tumors.

Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter.

Science.gov (United States)

Chianelli, M; Bizzarri, G; Todino, V; Misischi, I; Bianchini, A; Graziano, F; Guglielmi, R; Pacella, C M; Gharib, H; Papini, E

2014-07-01

It is normally recognized that the preferred treatment in large toxic thyroid nodules should be thyroidectomy. The aim of the study was to assess the efficacy of combined laser ablation treatment (LAT) and radioiodine 131 (131I) treatment of large thyroid toxic nodules with respect to rapidity of control of local symptoms, of hyperthyroidism, and of reduction of administered 131I activity in patients at refusal or with contraindications to surgery. We conducted a pilot study at a single center specializing in thyroid care. Fifteen patients were treated with LAT, followed by 131I (group A), and a series of matched consecutive patients were treated by 131I only (group B). Laser energy was delivered with an output power of 3 W (1800 J per fiber per treatment) through two 75-mm, 21-gauge spinal needles. Radioiodine activity was calculated to deliver 200 Gy to the hyperfunctioning nodule. Thyroid function, thyroid peroxidase antibody, thyroglobulin antibody, ultrasound, and local symptoms were measured at baseline and up to 24 months. Nodule volume reduction at 24 months was: 71.3 ± 13.4 vs 47.4 ± 5.5%, group A (LAT+131I) vs group B (131I), respectively; P symptom score demonstrated a more rapid reduction in group A (LAT+131I). In three cases, no 131I treatment was needed after LAT. In this pilot study, combined LAT/131I treatment induced faster and greater improvement of local and systemic symptoms compared to 131I only. This approach seems a possible alternative to thyroidectomy in patients at refusal of surgery.

Evaluation of the implementation of the directly observed treatment strategy for tuberculosis in a large city.

Science.gov (United States)

Lavôr, Débora Cristina Brasil da Silva; Pinheiro, Jair Dos Santos; Gonçalves, Maria Jacirema Ferreira

2016-04-01

To assess the degree of implementation of the Directly Observed Treatment, Short-course - DOTS for tuberculosis (TB) in a large city. Assessment of the implementation of the logic model, whose new cases of infectious pulmonary TB were recruited from specialized clinics and followed-up in basic health units. The judgment matrix covering the five components of the DOTS strategy were used. The result of the logic model indicates DOTS was partially implemented. In external, organizational and implementation contexts, the DOTS strategy was partially implemented; and, the effectiveness was not implemented. The partial implementation of the DOTS strategy in the city of Manaus did not reflect in TB control compliance, leading to low effectiveness of the program. Avaliar o grau de implantação da estratégia de tratamento diretamente observado (Directly Observed Treatment, Short-course - DOTS) para tuberculose (TB) em um município de grande porte. Avaliação de implantação por meio de modelo lógico, cujos casos novos de TB pulmonar bacilífera foram recrutados em ambulatórios especializados e acompanhados nas unidades básicas de saúde. Utilizou-se matriz de julgamento que abrange os cinco componentes da estratégia DOTS. O resultado do modelo lógico indica DOTS implantada parcialmente. Nos contextos externo, organizacional e de implantação, a estratégia DOTS está implantada parcialmente; e, na efetividade não está implantada. A implantação parcial da estratégia DOTS, na cidade de Manaus, reflete na não conformidade do controle da TB, levando à baixa efetividade do programa.

Effectiveness of cryotherapy treatment for cervical intraepithelial neoplasia.

Science.gov (United States)

Luciani, Silvana; Gonzales, Miguel; Munoz, Sergio; Jeronimo, Jose; Robles, Sylvia

2008-05-01

To assess the effectiveness of cryotherapy treatment delivered by general practitioners in primary care settings, as part of a screen-and-treat approach for cervical cancer prevention. Women aged between 25 and 49 years residing in San Martin, Peru, who were positive on visual inspection screening were treated, if eligible, with cryotherapy following biopsy. At 12 months post cryotherapy treatment the participants were evaluated for treatment effectiveness and examined by visual inspection and Papanicolaou test and, if positive, referred to a gynecologist for colposcopy and biopsy. Cryotherapy treatment was performed for 1398 women; of these, 531 (38%) had a histology result of cervical intraepithelial neoplasia (CIN). Cryotherapy effectively cured CIN in 418 (88%) women, including 49 (70%) women with a baseline diagnosis of CIN 3. Cryotherapy is an effective treatment for cervical precancerous lesions; it can easily be administered by general practitioners in primary care settings following visual inspection screening.

Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment

DEFF Research Database (Denmark)

Levin, Klaus; Madsen, Jette R; Petersen, Inge

2013-01-01

been offered expert diabetes care using teleconsultations. This article describes the impact of the telemedicine solution on essential diabetes treatment parameters, patient satisfaction, and cost-effectiveness. METHODS: Telemedicine consultations were conducted with the patient and nurse specialist...... in transportation time (7 h). Reductions in traveling costs and saved working days were the most important factors in making the telemedicine set-up economically efficient. CONCLUSION: Telemedicine consultation for remote outpatient diabetes control is feasible, and the interdisciplinary interventions achieved high...... treatment quality results in essential diabetes treatment parameters. In addition, the telemedicine set-up was associated with improved cost-effectiveness and patient satisfaction....

Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010.

LENUS (Irish Health Repository)

Bennett, Kathleen

2009-01-01

OBJECTIVE: Coronary heart disease (CHD) is associated with a large burden of disease in Ireland and is responsible for more than 6000 deaths annually. This study examined the cost-effectiveness of specific CHD treatments in Ireland. METHODS: Irish epidemiological data on patient numbers and median survival in specific groups, plus the uptake, effectiveness, and costs of specific interventions, all stratified by age and sex, were incorporated into a previously validated CHD mortality model, the IMPACT model. This model calculates the number of life-years gained (LYGs) by specific cardiology interventions to generate incremental cost-effectiveness ratios (ICERs) per LYG for each intervention. RESULTS: In 2000, medical and surgical treatments together prevented or postponed approximately 1885 CHD deaths in patients aged 25 to 84 years, and thus generated approximately 14,505 extra life-years (minimum 7270, maximum 22,475). In general, all the cardiac interventions investigated were highly cost-effective in the Irish setting. Aspirin, beta-blockers, ACE inhibitors, spironolactone, and warfarin for specific conditions were the most cost-effective interventions (< euro 3000\\/LYG), followed by the statins for secondary prevention (< euro 6500\\/LYG). Revascularization for chronic angina and primary angioplasty for myocardial infarction, although still cost-effective, had the highest ICER (between euro 12,000 and euro 20,000\\/LYG). CONCLUSIONS: Using a comprehensive standardized methodology, cost-effectiveness ratios in this study clearly favored simple medical treatments for myocardial infarction, secondary prevention, angina, and heart failure.

Correlated Effects of Ocean Acidification and Warming on Behavioral and Metabolic Traits of a Large Pelagic Fish

Directory of Open Access Journals (Sweden)

Taryn D. Laubenstein

2018-05-01

Full Text Available Ocean acidification and warming are co-occurring stressors, yet their effects on early life stages of large pelagic fishes are not well known. Here, we determined the effects of elevated CO2 and temperature at levels projected for the end of the century on activity levels, boldness, and metabolic traits (i.e., oxygen uptake rates in larval kingfish (Seriola lalandi, a large pelagic fish with a circumglobal distribution. We also examined correlations between these behavioral and physiological traits measured under different treatments. Kingfish were reared from the egg stage to 25 days post-hatch in a full factorial design of ambient and elevated CO2 (~500 µatm and ~1000 µatm and temperature (21 °C and 25 °C. Activity levels were higher in fish from the elevated temperature treatment compared with fish reared under ambient temperature. However, elevated CO2 did not affect activity, and boldness was not affected by either elevated CO2 or temperature. Both elevated CO2 and temperature resulted in increased resting oxygen uptake rates compared to fish reared under ambient conditions, but neither affected maximum oxygen uptake rates nor aerobic scope. Resting oxygen uptake rates and boldness were negatively correlated under ambient temperature, but positively correlated under elevated temperature. Maximum oxygen uptake rates and boldness were also negatively correlated under ambient temperature. These findings suggest that elevated temperature has a greater impact on behavioral and physiological traits of larval kingfish than elevated CO2. However, elevated CO2 exposure did increase resting oxygen uptake rates and interact with temperature in complex ways. Our results provide novel behavioral and physiological data on the responses of the larval stage of a large pelagic fish to ocean acidification and warming conditions, demonstrate correlations between these traits, and suggest that these correlations could influence the direction and pace of

Isolating relativistic effects in large-scale structure

Science.gov (United States)

Bonvin, Camille

2014-12-01

We present a fully relativistic calculation of the observed galaxy number counts in the linear regime. We show that besides the density fluctuations and redshift-space distortions, various relativistic effects contribute to observations at large scales. These effects all have the same physical origin: they result from the fact that our coordinate system, namely the galaxy redshift and the incoming photons’ direction, is distorted by inhomogeneities in our Universe. We then discuss the impact of the relativistic effects on the angular power spectrum and on the two-point correlation function in configuration space. We show that the latter is very well adapted to isolate the relativistic effects since it naturally makes use of the symmetries of the different contributions. In particular, we discuss how the Doppler effect and the gravitational redshift distortions can be isolated by looking for a dipole in the cross-correlation function between a bright and a faint population of galaxies.

Large-scale production of graphitic carbon nitride with outstanding nitrogen photofixation ability via a convenient microwave treatment

International Nuclear Information System (INIS)

Ma, Huiqiang; Shi, Zhenyu; Li, Shuang; Liu, Na

2016-01-01

Highlights: • Microwave method for synthesizing g-C_3N_4 with N_2 photofixation ability is reported. • Nitrogen vacancies play the important role on the nitrogen photofixation ability. • The present process is a convenient method for large-scale production of g-C_3N_4. - Abstract: A convenient microwave treatment for synthesizing graphitic carbon nitride (g-C_3N_4) with outstanding nitrogen photofixation ability under visible light is reported. X-ray diffraction (XRD), N_2 adsorption, UV–vis spectroscopy, SEM, N_2-TPD, EPR, photoluminescence (PL) and photocurrent measurements were used to characterize the prepared catalysts. The results indicate that microwave treatment can form many irregular pores in as-prepared g-C_3N_4, which causes the increased surface area and separation rate of electrons and holes. More importantly, microwave treatment causes the formation of many nitrogen vacancies in as-prepared g-C_3N_4. These nitrogen vacancies not only serve as active sites to adsorb and activate N_2 molecules but also promote interfacial charge transfer from catalysts to N_2 molecules, thus significantly improving the nitrogen photofixation ability. Moreover, the present process is a convenient method for large-scale production of g-C_3N_4 which is significantly important for the practical application.

Effects of spot parameters in pencil beam scanning treatment planning.

Science.gov (United States)

Kraan, Aafke Christine; Depauw, Nicolas; Clasie, Ben; Giunta, Marina; Madden, Tom; Kooy, Hanne M

2018-01-01

Spot size σ (in air at isocenter), interspot spacing d, and spot charge q influence dose delivery efficiency and plan quality in Intensity Modulated Proton Therapy (IMPT) treatment planning. The choice and range of parameters varies among different manufacturers. The goal of this work is to demonstrate the influence of the spot parameters on dose quality and delivery in IMPT treatment plans, to show their interdependence, and to make practitioners aware of the spot parameter values for a certain facility. Our study could help as a guideline to make the trade-off between treatment quality and time in existing PBS centers and in future systems. We created plans for seven patients and a phantom, with different tumor sites and volumes, and compared the effect of small-, medium-, and large-spot widths (σ = 2.5, 5, and 10 mm) and interspot distances (1σ, 1.5σ, and 1.75σ) on dose, spot charge, and treatment time. Moreover, we quantified how postplanning charge threshold cuts affect plan quality and the total number of spots to deliver, for different spot widths and interspot distances. We show the effect of a minimum charge (or MU) cutoff value for a given proton delivery system. Spot size had a strong influence on dose: larger spots resulted in more protons delivered outside the target region. We observed dose differences of 2-13 Gy (RBE) between 2.5 mm and 10 mm spots, where the amount of extra dose was due to dose penumbra around the target region. Interspot distance had little influence on dose quality for our patient group. Both parameters strongly influence spot charge in the plans and thus the possible impact of postplanning charge threshold cuts. If such charge thresholds are not included in the treatment planning system (TPS), it is important that the practitioner validates that a given combination of lower charge threshold, interspot spacing, and spot size does not result in a plan degradation. Low average spot charge occurs for small spots, small interspot

Exploring the Impact of Parental Psychopathology and Emotion Regulation on Evidence-Based Parenting Interventions: A Transdiagnostic Approach to Improving Treatment Effectiveness

Science.gov (United States)

Maliken, Ashley C.; Katz, Lynn Fainsilber

2013-01-01

Parenting interventions, particularly those categorized as parent management training (PMT), have a large evidence base supporting their effectiveness with most families who present for treatment of childhood behavior problems. However, data suggest that PMTs are not effective at treating all families who seek services. Parental psychopathology…

Towards better treatment outcomes in childhood asthma

NARCIS (Netherlands)

Koster, E.S.

2011-01-01

Standard treatment for peadiatric asthmatics is based on regular use of inhaled corticosteroids (ICS) combined with short-acting beta-agonists (SABA). Despite the effectiveness of this standard treatment strategy in most patients, there is large variability in treatment response. Many factors can

Effects of natalizumab treatment on Foxp3+ T regulatory cells.

Science.gov (United States)

Stenner, Max-Philipp; Waschbisch, Anne; Buck, Dorothea; Doerck, Sebastian; Einsele, Hermann; Toyka, Klaus V; Wiendl, Heinz

2008-10-06

Natalizumab, a monoclonal humanized antibody targeting the alpha-4 chain of very late activation antigen 4 (VLA-4) exerts impressive therapeutic effects in patients with relapsing-remitting multiple sclerosis. Our objective was to study impacts of Natalizumab therapy on Foxp3+ T regulatory cells (Tregs) in multiple sclerosis (MS) patients. A combined approach of in vitro and ex vivo experiments using T cells isolated from the peripheral blood of healthy donors and Natalizumab treated MS patients was chosen. We determined binding of Natalizumab and its effects on the frequency, transmigratory behaviour and suppressive function of Tregs. Binding of Natalizumab and expression of CD49d (alpha-4 chain of VLA-4) differed between non-regulatory and regulatory cells. Albeit Foxp3+ Tregs had lower levels of CD49d, Natalizumab blocked the transmigration of Foxp3+ Tregs similar to non-regulatory T cells. The frequency of peripheral blood Tregs was unaffected by Natalizumab treatment. Natalizumab does not alter the suppressive capacity of CD4+CD25(high)CD127(low)Foxp3+ Tregs under in vitro conditions. Furthermore, the impaired function of Tregs in MS patients is not restored by Natalizumab treatment. We provide a first detailed analysis of Natalizumab effects on the regulatory T cell population. Our prospective study shows that Foxp3+ Tregs express lower levels of VLA-4 and bind less Natalizumab. We further the understanding of the mechanisms of action of Natalizumab by demonstrating that unlike other immunomodulatory drugs the beneficial therapeutic effects of the monoclonal antibody are largely independent of alterations in Treg frequency or function.

Oculomotor and neuropsychological effects of antipsychotic treatment for schizophrenia

Directory of Open Access Journals (Sweden)

Kristian S. Hill

2009-04-01

Full Text Available Cognitive enhancement has become an important target for drug therapies in schizophrenia. Treatment development in this area requires assessment approaches that are sensitive to procognitive effects of antipsychotic and adjunctive treatments. Ideally, new treatments will have translational characteristics for parallel human and animal research. Previous studies of antipsychotic effects on cognition have relied primarily on paper-and-pencil neuropsychological testing. No study has directly compared neurophysiological biomarkers and neuropsychological testing as strategies for assessing cognitive effects of antipsychotic treatment early in the course of schizophrenia. Anti psychotic-naive patients with schizophrenia were tested before treatment with risperidone and again 6 weeks later. Matched healthy participants were tested over a similar time period. Test-retest reliability, effect sizes of within-subject change, and multivariate/univariate analysis of variance were used to compare 3 neurophysiological tests (visually guided saccade, memory-guided saccade, and antisaccade with neuropsychological tests covering 4 cognitive domains (executive function, attention, memory, and manual motor function. While both measurement approaches showed robust neurocognitive impairments in patients prior to risperidone treatment, oculomotor biomarkers were more sensitive to treatment-related effects on neurocognitive function than traditional neuropsychological measures. Further, unlike the pattern of modest generalized cognitive improvement suggested by neuropsychological measures, the oculomotor findings revealed a mixed pattern of beneficial and adverse treatment related effects. These findings warrant further investigation regarding the utility of neurophysiological biomarkers for assessing cognitive outcomes of antipsychotic treatment in clinical trials and in early-phase drug development.

Strategies for the cost effective treatment of Oak Ridge legacy wastes

International Nuclear Information System (INIS)

Compere, A.L.; Griffith, W.L.; Huxtable, W.P.; Wilson, D.F.

1998-03-01

Research and development treatment strategies for treatment or elimination of several Oak Ridge plant liquid, solid, and legacy wastes are detailed in this report. Treatment strategies for volumetrically contaminated nickel; enriched uranium-contaminated alkali metal fluorides; uranium-contaminated aluminum compressor blades; large, mercury-contaminated lithium isotope separations equipment; lithium process chlorine gas streams; high-concentration aluminum nitrate wastes, and high-volume, low-level nitrate wastes are discussed. Research needed to support engineering development of treatment processes is detailed

Short-Term Cognitive-Behavioural Group Treatment for Hoarding Disorder: A Naturalistic Treatment Outcome Study.

Science.gov (United States)

Moulding, Richard; Nedeljkovic, Maja; Kyrios, Michael; Osborne, Debra; Mogan, Christopher

2017-01-01

The study aim was to test whether a 12-week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy-based hoarding treatment, would be efficacious in a community-based setting. Over a 3-year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community-based naturalistic study, only 41 completed the post-treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in-session exposure to sorting and discarding, and cognitive and behavioural techniques to support out-of-session sorting and discarding, and nonacquiring. Self-report measures used to assess treatment effect were the Savings Inventory-Revised (SI-R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre-post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI-R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding-related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post-treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12-week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd. A 12-week group programme delivered in a community setting was effective for helping with

Effects of large bending deflections on blade flutter limits

Energy Technology Data Exchange (ETDEWEB)

Kallesoee, Bjarne Skovmose; Hartvig Hansen, Morten

2008-04-15

The coupling of bending and torsion due to large blade bending are assumed to have some effects of the flutter limits of wind turbines. In the present report, the aeroelastic blade model suggested by Kallesoee, which is similar to a second order model, is used to investigate the aeroelastic stability limits of the RWT blade with and without the effects of the large blade deflection. The investigation shows no significant change of the flutter limit on the rotor speed due to the blade deflection,whereas the first edgewise bending mode becomes negatively damped due to the coupling with blade torsion which causes a change of the effective direction of blade vibration. These observations are confirmed by nonlinear aeroelastic simulations using HAWC2. This work is part of the UpWind project funded by the European Commission under the contract number SES6-CT-2005-019945 which is gratefully acknowledged. This report is the deliverable D2.3 of the UpWind project. (au)

Effect of Cold Drawing and Heat Treatment on the Microstructure of Invar36 Alloy Wire

International Nuclear Information System (INIS)

Han, Seung Youb; Jang, Seon Ah; Eun, Hee-Chul; Choi, Jung-Hoon; Lee, Ki Rak; Park, Hwan Seo; Ahn, Do-Hee; Kim, Soo Young; Kim, Jea Youl; Shin, Sang Yong

2016-01-01

In this study, the effect of cold drawing and heat treatment on the microstructure of Invar36 alloy wire was investigated. Invar36 alloy wire is used as a transmission line core material, and is required to have high strength. The diameter of the Invar36 alloy wire specimens were reduced from 16 mm to 4.3 mm after three cold drawing and two heat treatment processes, thereby increasing tensile strength. Specimens were taken after each of the cold drawing and heat treatment processes, and their microstructure and tensile properties were analyzed. The Invar36 alloy wire had a γ-(Fe, Ni) phase matrix before the cold drawing and heat treatment processes. After the cold drawing processes, {220} and {200} textures were mainly achieved. After the heat treatment processes, a {200} recrystallization γ-(Fe, Ni) phase was formed with fine carbides. The recrystallization γ-(Fe, Ni) phase grains had low dislocation density, so they probably accommodated a large amount of deformation during the cold drawing processes.

Effect of Cold Drawing and Heat Treatment on the Microstructure of Invar36 Alloy Wire

Energy Technology Data Exchange (ETDEWEB)

Han, Seung Youb; Jang, Seon Ah; Eun, Hee-Chul; Choi, Jung-Hoon; Lee, Ki Rak; Park, Hwan Seo; Ahn, Do-Hee [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Soo Young; Kim, Jea Youl [RandD Center, KOS Ltd., Yangsan (Korea, Republic of); Shin, Sang Yong [University of Ulsan, Ulsan (Korea, Republic of)

2016-10-15

In this study, the effect of cold drawing and heat treatment on the microstructure of Invar36 alloy wire was investigated. Invar36 alloy wire is used as a transmission line core material, and is required to have high strength. The diameter of the Invar36 alloy wire specimens were reduced from 16 mm to 4.3 mm after three cold drawing and two heat treatment processes, thereby increasing tensile strength. Specimens were taken after each of the cold drawing and heat treatment processes, and their microstructure and tensile properties were analyzed. The Invar36 alloy wire had a γ-(Fe, Ni) phase matrix before the cold drawing and heat treatment processes. After the cold drawing processes, {220} and {200} textures were mainly achieved. After the heat treatment processes, a {200} recrystallization γ-(Fe, Ni) phase was formed with fine carbides. The recrystallization γ-(Fe, Ni) phase grains had low dislocation density, so they probably accommodated a large amount of deformation during the cold drawing processes.

Cost-effective treatment for the couple with infertility.

Science.gov (United States)

Van Voorhis, B J; Syrop, C H

2000-12-01

Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated.

A large mixing effect on eta,eta' and iota

International Nuclear Information System (INIS)

Kawai, E.

1983-01-01

We quantitatively investigate a possible large mixing effect on eta(549), eta'(958) and iota(1440) in a phenomenological way, taking both SU(3) symmetry breaking and gluon intervention into due account. (orig.)

Estimating the effect of treatment rate changes when treatment benefits are heterogeneous: antibiotics and otitis media.

Science.gov (United States)

Park, Tae-Ryong; Brooks, John M; Chrischilles, Elizabeth A; Bergus, George

2008-01-01

Contrast methods to assess the health effects of a treatment rate change when treatment benefits are heterogeneous across patients. Antibiotic prescribing for children with otitis media (OM) in Iowa Medicaid is the empirical example. Instrumental variable (IV) and linear probability model (LPM) are used to estimate the effect of antibiotic treatments on cure probabilities for children with OM in Iowa Medicaid. Local area physician supply per capita is the instrument in the IV models. Estimates are contrasted in terms of their ability to make inferences for patients whose treatment choices may be affected by a change in population treatment rates. The instrument was positively related to the probability of being prescribed an antibiotic. LPM estimates showed a positive effect of antibiotics on OM patient cure probability while IV estimates showed no relationship between antibiotics and patient cure probability. Linear probability model estimation yields the average effects of the treatment on patients that were treated. IV estimation yields the average effects for patients whose treatment choices were affected by the instrument. As antibiotic treatment effects are heterogeneous across OM patients, our estimates from these approaches are aligned with clinical evidence and theory. The average estimate for treated patients (higher severity) from the LPM model is greater than estimates for patients whose treatment choices are affected by the instrument (lower severity) from the IV models. Based on our IV estimates it appears that lowering antibiotic use in OM patients in Iowa Medicaid did not result in lost cures.

Surgical treatment of a large congenital cavernous hemangioma on the thorax of a foal

DEFF Research Database (Denmark)

Jacobsen, Stine; Christophersen, Mogens Teken; Tnibar, Aziz

2018-01-01

A 3-day-old male foal was presented with a fluctuant 25 × 15 cm mass on the thorax. The mass had increased in size since birth. The mass did not respond to conservative treatment consisting of aspiration of serohaemorrhagic contents and compression bandages, and it was therefore surgically removed...... when the foal was approximately 2½ weeks. A histopathological diagnosis of cavernous haemangioma was made. Healing progressed without complications despite a large surgical wound left to heal by second intention. Recurrence was not observed during the 1.5-year follow-up period....

Comparative study of 6 MV and 15 MV treatment plans for large chest wall irradiation

International Nuclear Information System (INIS)

Prasana Sarathy, N.; Kothanda Raman, S.; Sen, Dibyendu; Pal, Bipasha

2007-01-01

Conventionally, opposed tangential fields are used for the treatment of chest wall irradiation. If the chest wall is treated in the linac, 4 or 6 MV photons will be the energy of choice. It is a welI-established rule that for chest wall separations up to 22 cm, one can use mid-energies, with acceptable volume of hot spots. For larger patient sizes (22 cm and above), mid-energy beams produce hot spots over large volumes. The purpose of this work is to compare plans made with 6 and 15 MV photons, for patients with large chest wall separations. The obvious disadvantage in using high-energy photons for chest wall irradiation is inadequate dose to the skin. But this can be compensated by using a bolus of suitable thickness

Instrumental variable estimation of treatment effects for duration outcomes

NARCIS (Netherlands)

G.E. Bijwaard (Govert)

2007-01-01

textabstractIn this article we propose and implement an instrumental variable estimation procedure to obtain treatment effects on duration outcomes. The method can handle the typical complications that arise with duration data of time-varying treatment and censoring. The treatment effect we

Research on common methods for evaluating the operation effect of integrated wastewater treatment facilities of iron and steel enterprises

Science.gov (United States)

Bingsheng, Xu

2017-04-01

Considering the large quantities of wastewater generated from iron and steel enterprises in China, this paper is aimed to research the common methods applied for evaluating the integrated wastewater treatment effect of iron and steel enterprises. Based on survey results on environmental protection performance, technological economy, resource & energy consumption, services and management, an indicator system for evaluating the operation effect of integrated wastewater treatment facilities is set up. By discussing the standards and industrial policies in and out of China, 27 key secondary indicators are further defined on the basis of investigation on main equipment and key processes for wastewater treatment, so as to determine the method for setting key quantitative and qualitative indicators for evaluation indicator system. It is also expected to satisfy the basic requirements of reasonable resource allocation, environmental protection and sustainable economic development, further improve the integrated wastewater treatment effect of iron and steel enterprises, and reduce the emission of hazardous substances and environmental impact.

Beyond the treatment effect: Evaluating the effects of patient preferences in randomised trials.

Science.gov (United States)

Walter, S D; Turner, R; Macaskill, P; McCaffery, K J; Irwig, L

2017-02-01

The treatments under comparison in a randomised trial should ideally have equal value and acceptability - a position of equipoise - to study participants. However, it is unlikely that true equipoise exists in practice, because at least some participants may have preferences for one treatment or the other, for a variety of reasons. These preferences may be related to study outcomes, and hence affect the estimation of the treatment effect. Furthermore, the effects of preferences can sometimes be substantial, and may even be larger than the direct effect of treatment. Preference effects are of interest in their own right, but they cannot be assessed in the standard parallel group design for a randomised trial. In this paper, we describe a model to represent the impact of preferences on trial outcomes, in addition to the usual treatment effect. In particular, we describe how outcomes might differ between participants who would choose one treatment or the other, if they were free to do so. Additionally, we investigate the difference in outcomes depending on whether or not a participant receives his or her preferred treatment, which we characterise through a so-called preference effect. We then discuss several study designs that have been proposed to measure and exploit data on preferences, and which constitute alternatives to the conventional parallel group design. Based on the model framework, we determine which of the various preference effects can or cannot be estimated with each design. We also illustrate these ideas with some examples of preference designs from the literature.

Effects of Cancer Treatment on Fertility (For Parents)

Science.gov (United States)

... Mind Sexual Health Food & Fitness Diseases & Conditions Infections Drugs & Alcohol School & Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Effects of Cancer Treatment on Fertility KidsHealth / For Parents / Effects of Cancer Treatment on ...

Improved treatment of radiation effects on the skin

International Nuclear Information System (INIS)

Wandl, E.O.; Kaercher, K.H.; Wandl-Hainberger, I.

1985-01-01

The treatment concept developed by K.H. Kaercher was extended by a therapy using Elasten S cream. In the course of a highvoltage therapy using fast electrons or cobalt-60, interesting aspects in the treatment and progression of the radiation reactions of the skin were established. The dermato-therapeutic principles layed down by K.H. Kaercher with the treatment palette used hitherto, have without doubt invariably proven their value. The exclusive powder treatment, however, may be made more practical by application of the new treatment cream in accordance with the intervals in radiation treatment or as a basic treatment towards the end of therapy. Furthermore it is ideally suited for the care and after-treatment of skin, strained by radiation. It reduces considerably the remaining visible radiation reactions. The treatment with powder and emulsion has for more than 10 years proven effective. After the excellent results of the new cream during radiation treatment, additional positive effects are expected in a long-term trial which will be reported on separately. (orig.) [de

Gluon bremstrahlung effects in large P/sub perpendicular/ hadron-hadron scattering

International Nuclear Information System (INIS)

Fox, G.C.; Kelly, R.L.

1982-02-01

We consider effects of parton (primarily gluon) bremstrahlung in the initial and final states of high transverse momentum hadron-hadron scattering. Monte Carlo calculations based on conventional QCD parton branching and scattering processes are presented. The calculations are carried only to the parton level in the final state. We apply the model to the Drell-Yan process and to high transverse momentum hadron-hadron scattering triggered with a large aperture calorimeter. We show that the latter triggers are biased in that they select events with unusually large bremstrahlung effects. We suggest that this trigger bias explains the large cross section and non-coplanar events observed in the NA5 experiment at the SPS

Beyond Autism Treatment: The Application of Applied Behavior Analysis in the Treatment of Emotional and Psychological Disorders

Science.gov (United States)

Ross, Robert K.

2007-01-01

The field of applied behavior analysis (ABA) has increasingly come to be associated with the treatment of autism in young children. This phenomenon is largely the result of empirical research demonstrating effective treatment outcomes in this population. The same cannot be said with regard to the treatment of conditions often referred to as…

Estimating scaled treatment effects with multiple outcomes.

Science.gov (United States)

Kennedy, Edward H; Kangovi, Shreya; Mitra, Nandita

2017-01-01

In classical study designs, the aim is often to learn about the effects of a treatment or intervention on a single outcome; in many modern studies, however, data on multiple outcomes are collected and it is of interest to explore effects on multiple outcomes simultaneously. Such designs can be particularly useful in patient-centered research, where different outcomes might be more or less important to different patients. In this paper, we propose scaled effect measures (via potential outcomes) that translate effects on multiple outcomes to a common scale, using mean-variance and median-interquartile range based standardizations. We present efficient, nonparametric, doubly robust methods for estimating these scaled effects (and weighted average summary measures), and for testing the null hypothesis that treatment affects all outcomes equally. We also discuss methods for exploring how treatment effects depend on covariates (i.e., effect modification). In addition to describing efficiency theory for our estimands and the asymptotic behavior of our estimators, we illustrate the methods in a simulation study and a data analysis. Importantly, and in contrast to much of the literature concerning effects on multiple outcomes, our methods are nonparametric and can be used not only in randomized trials to yield increased efficiency, but also in observational studies with high-dimensional covariates to reduce confounding bias.

Successful treatment of a large oral verrucous hyperplasia with photodynamic therapy combined with cryotherapy

Directory of Open Access Journals (Sweden)

Yu-Chao Chang

2013-03-01

Full Text Available Studies have shown that topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT can be used successfully for the treatment of oral verrucous hyperplasia (OVH. Studies have also demonstrated that cryotherapy could be used as a treatment modality for OVH lesions. In this case report, we tested the efficacy of topical ALA-PDT, combined with cryogun cryotherapy, for an extensive OVH lesion on the right buccal mucosa of a 65-year-old male areca quid chewer. The tumor was cleared after six treatments of combined topical ALA-PDT and cryogun cryotherapy. No recurrence of the lesion was found after a follow-up period of 18 months. We suggest that our combined treatment protocol may be effective in treating OVH lesions. The treatment course may be slightly shortened with this combined protocol and was well tolerated by the patient.

The Effects of Group Relaxation Training/Large Muscle Exercise, and Parental Involvement on Attention to Task, Impulsivity, and Locus of Control among Hyperactive Boys.

Science.gov (United States)

Porter, Sally S.; Omizo, Michael M.

1984-01-01

The study examined the effects of group relaxation training/large muscle exercise and parental involvement on attention to task, impulsivity, and locus of control among 34 hyperactive boys. Following treatment both experimental groups recorded significantly higher attention to task, lower impulsivity, and lower locus of control scores. (Author/CL)

Stimulation treatments of large-seed leguminous plants Pt. 1

International Nuclear Information System (INIS)

Nagy, Istvan; Borbely, Ferenc; Nagy, Janos; Dezsi, Zoltan

1983-01-01

The effect of low dose X-ray irradiation on the sprouting and initial growth of some leguminous plants was studied. After having the seeds of peas, beans, lupines and horse beans irradiated, the sprouting rate, the amount of sprouting plants, the length of the roots, the sprouts and the sprouting plants, the electrolyte conductivity and the water uptake were determined. The height and the amount of the plants were measured after a period of 6 weeks. According to the sprout-length values, an increased variation in the plant features can be observed as a result of irradiation treatment: both stimulation and inhibition of plant growth occured, depending on the variety of the leguminosae. The indices of sprouting and initial growth agree well with each other. (V.N.)

Inhalable oridonin-loaded poly(lactic-co-glycolicacid large porous microparticles for in situ treatment of primary non-small cell lung cancer

Directory of Open Access Journals (Sweden)

Lifei Zhu

2017-01-01

Full Text Available Non-small cell lung cancer (NSCLC accounts for about 85% of all lung cancers. Traditional chemotherapy for this disease leads to serious side effects. Here we prepared an inhalable oridonin-loaded poly(lactic-co-glycolicacid (PLGA large porous microparticle (LPMP for in situ treatment of NSCLC with the emulsion/solvent evaporation/freeze-drying method. The LPMPs were smooth spheres with many internal pores. Despite a geometric diameter of ~10 µm, the aerodynamic diameter of the spheres was only 2.72 µm, leading to highly efficient lung deposition. In vitro studies showed that most of oridonin was released after 1 h, whereas the alveolar macrophage uptake of LPMPs occurred after 8 h, so that most of oridonin would enter the surroundings without undergoing phagocytosis. Rat primary NSCLC models were built and administered with saline, oridonin powder, gemcitabine, and oridonin-loaded LPMPs via airway, respectively. The LPMPs showed strong anticancer effects. Oridonin showed strong angiogenesis inhibition and apoptosis. Relevant mechanisms are thought to include oridonin-induced mitochondrial dysfunction accompanied by low mitochondrial membrane potentials, downregulation of BCL-2 expressions, upregulation of expressions of BAX, caspase-3 and caspase-9. The oridonin-loaded PLGA LPMPs showed high anti-NSCLC effects after pulmonary delivery. In conclusion, LPMPs are promising dry powder inhalations for in situ treatment of lung cancer.

Effect of pioglitazone treatment on behavioral symptoms in autistic children

Directory of Open Access Journals (Sweden)

Edelson Stephen M

2007-01-01

Full Text Available Abstract Introduction Autism is complex neuro-developmental disorder which has a symptomatic diagnosis in patients characterized by disorders in language/communication, behavior, and social interactions. The exact causes for autism are largely unknown, but is has been speculated that immune and inflammatory responses, particularly those of Th2 type, may be involved. Thiazolidinediones (TZDs are agonists of the peroxisome proliferator activated receptor gamma (PPARγ, a nuclear hormone receptor which modulates insulin sensitivity, and have been shown to induce apoptosis in activated T-lymphocytes and exert anti-inflammatory effects in glial cells. The TZD pioglitazone (Actos is an FDA-approved PPARγ agonist used to treat type 2 diabetes, with a good safety profile, currently being tested in clinical trials of other neurological diseases including AD and MS. We therefore tested the safety and therapeutic potential of oral pioglitazone in a small cohort of children with diagnosed autism. Case description The rationale and risks of taking pioglitazone were explained to the parents, consent was obtained, and treatment was initiated at either 30 or 60 mg per day p.o. A total of 25 children (average age 7.9 ± 0.7 year old were enrolled. Safety was assessed by measurements of metabolic profiles and blood pressure; effects on behavioral symptoms were assessed by the Aberrant Behavior Checklist (ABC, which measures hyperactivity, inappropriate speech, irritability, lethargy, and stereotypy, done at baseline and after 3–4 months of treatment. Discussion and evaluation In a small cohort of autistic children, daily treatment with 30 or 60 mg p.o. pioglitazone for 3–4 months induced apparent clinical improvement without adverse events. There were no adverse effects noted and behavioral measurements revealed a significant decrease in 4 out of 5 subcategories (irritability, lethargy, stereotypy, and hyperactivity. Improved behaviors were inversely

Possible future effects of large-scale algae cultivation for biofuels on coastal eutrophication in Europe.

Science.gov (United States)

Blaas, Harry; Kroeze, Carolien

2014-10-15

Biodiesel is increasingly considered as an alternative for fossil diesel. Biodiesel can be produced from rapeseed, palm, sunflower, soybean and algae. In this study, the consequences of large-scale production of biodiesel from micro-algae for eutrophication in four large European seas are analysed. To this end, scenarios for the year 2050 are analysed, assuming that in the 27 countries of the European Union fossil diesel will be replaced by biodiesel from algae. Estimates are made for the required fertiliser inputs to algae parks, and how this may increase concentrations of nitrogen and phosphorus in coastal waters, potentially leading to eutrophication. The Global NEWS (Nutrient Export from WaterSheds) model has been used to estimate the transport of nitrogen and phosphorus to the European coastal waters. The results indicate that the amount of nitrogen and phosphorus in the coastal waters may increase considerably in the future as a result of large-scale production of algae for the production of biodiesel, even in scenarios assuming effective waste water treatment and recycling of waste water in algae production. To ensure sustainable production of biodiesel from micro-algae, it is important to develop cultivation systems with low nutrient losses to the environment. Copyright © 2014 Elsevier B.V. All rights reserved.

Large-scale production of graphitic carbon nitride with outstanding nitrogen photofixation ability via a convenient microwave treatment

Energy Technology Data Exchange (ETDEWEB)

Ma, Huiqiang [College of Chemistry, Chemical Engineering, and Environmental Engineering, Liaoning Shihua University, Fushun 113001 (China); College of Environment and Resources, Key Lab of Groundwater Resources and Environment, Ministry of Education, Jilin University, Changchun 130021 (China); Shi, Zhenyu; Li, Shuang [College of Chemistry, Chemical Engineering, and Environmental Engineering, Liaoning Shihua University, Fushun 113001 (China); Liu, Na, E-mail: Naliujlu@163.com [College of Environment and Resources, Key Lab of Groundwater Resources and Environment, Ministry of Education, Jilin University, Changchun 130021 (China)

2016-08-30

Highlights: • Microwave method for synthesizing g-C{sub 3}N{sub 4} with N{sub 2} photofixation ability is reported. • Nitrogen vacancies play the important role on the nitrogen photofixation ability. • The present process is a convenient method for large-scale production of g-C{sub 3}N{sub 4}. - Abstract: A convenient microwave treatment for synthesizing graphitic carbon nitride (g-C{sub 3}N{sub 4}) with outstanding nitrogen photofixation ability under visible light is reported. X-ray diffraction (XRD), N{sub 2} adsorption, UV–vis spectroscopy, SEM, N{sub 2}-TPD, EPR, photoluminescence (PL) and photocurrent measurements were used to characterize the prepared catalysts. The results indicate that microwave treatment can form many irregular pores in as-prepared g-C{sub 3}N{sub 4}, which causes the increased surface area and separation rate of electrons and holes. More importantly, microwave treatment causes the formation of many nitrogen vacancies in as-prepared g-C{sub 3}N{sub 4}. These nitrogen vacancies not only serve as active sites to adsorb and activate N{sub 2} molecules but also promote interfacial charge transfer from catalysts to N{sub 2} molecules, thus significantly improving the nitrogen photofixation ability. Moreover, the present process is a convenient method for large-scale production of g-C{sub 3}N{sub 4} which is significantly important for the practical application.

Interactive effects of fire and large herbivores on web-building spiders.

Science.gov (United States)

Foster, C N; Barton, P S; Wood, J T; Lindenmayer, D B

2015-09-01

Altered disturbance regimes are a major driver of biodiversity loss worldwide. Maintaining or re-creating natural disturbance regimes is therefore the focus of many conservation programmes. A key challenge, however, is to understand how co-occurring disturbances interact to affect biodiversity. We experimentally tested for the interactive effects of prescribed fire and large macropod herbivores on the web-building spider assemblage of a eucalypt forest understorey and investigated the role of vegetation in mediating these effects using path analysis. Fire had strong negative effects on the density of web-building spiders, which were partly mediated by effects on vegetation structure, while negative effects of large herbivores on web density were not related to changes in vegetation. Fire amplified the effects of large herbivores on spiders, both via vegetation-mediated pathways and by increasing herbivore activity. The importance of vegetation-mediated pathways and fire-herbivore interactions differed for web density and richness and also differed between web types. Our results demonstrate that for some groups of web-building spiders, the effects of co-occurring disturbance drivers may be mostly additive, whereas for other groups, interactions between drivers can amplify disturbance effects. In our study system, the use of prescribed fire in the presence of high densities of herbivores could lead to reduced densities and altered composition of web-building spiders, with potential cascading effects through the arthropod food web. Our study highlights the importance of considering both the independent and interactive effects of disturbances, as well as the mechanisms driving their effects, in the management of disturbance regimes.

[Recent research progress in immunomodulatory effects of Chinese herbal medicine on asthma treatment].

Science.gov (United States)

Zhou, Fang-Fang; Xu, Zhao-Xia; Adila, Aipire; Li, Jin-Yao

2017-10-01

Asthma is a kind of chronic respiratory inflammation, commonly with breathlessness, chest tightness, coughing, recurrent episodes of wheezing and airflow obstruction, severely affecting human health. A variety of immunocytes are involved in this chronic disease. Chinese herbal medicine(CHM) has a long history in the treatment of asthma. A large number of studies have shown that CHM could ameliorate asthma symptoms through regulating cellular immune responses. This paper reviewed the studies of CHM on the regulation of immunocytes and their mechanisms in recent years, including the count of inflammatory cells, maturation of dendritic cells, balance of helper T cell subtypes, induction of regulatory T cells and intracellular signaling pathways. We also proposed the future research directions about the effects of CHM on asthma treatment. Copyright© by the Chinese Pharmaceutical Association.

Patients knowledge about side effects of orthodontic treatment

Directory of Open Access Journals (Sweden)

Mia Amalia

2011-07-01

Full Text Available Disharmonious of dental arrangement can possibly create problems for the patient, such as the masticatory function, esthetical, psychosocial, and also the increased risk of trauma and periodontal disease. These are reasons for a patient to seek orthodontic treatment. The aim of this study was to know the patient’s knowledge about the side effects possibility that they receive during orthodontic treatment. The side effects include pain experience during orthodontic treatment, the possibility of soft tissue damage, email demineralization, loss of tooth vitality, periodontal problem, root resorption, temporomandibular joint disorders, and relapse. A cross-sectional study was conducted in patients who registered at Orthodontic Department, Faculty of Dentistry, Universitas Indonesia on March-June 2009. The participants of this study were 100 patients, consist of 86 women and 14 men respectively. Twenty-seven questions about the side-effects of orthodontic treatment were used to obtain the patient’s knowledge and the result was categorized into 3 groups, good, average and poor. The result of the study showed that patient’s knowledge about the side effect of pain experience during orthodontic treatment was average and the patient’s knowledge about the possibility of soft tissue damage due to orthodontic treatment was good. However, the patient’s knowledge about the possibility of email demineralization, loss of tooth vitality, periodontal problem, root resorption, temporomandibular joint disorders and relapse due to orthodontic treatment was low.

Quantum mechanical treatment of large spin baths

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Röhrig, Robin; Schering, Philipp; Gravert, Lars B.; Fauseweh, Benedikt; Uhrig, Götz S.

2018-04-01

The electronic spin in quantum dots can be described by central spin models (CSMs) with a very large number Neff≈104 to 106 of bath spins posing a tremendous challenge to theoretical simulations. Here, a fully quantum mechanical theory is developed for the limit Neff→∞ by means of iterated equations of motion (iEoM). We find that the CSM can be mapped to a four-dimensional impurity coupled to a noninteracting bosonic bath in this limit. Remarkably, even for infinite bath the CSM does not become completely classical. The data obtained by the proposed iEoM approach are tested successfully against data from other, established approaches. Thus the iEoM mapping extends the set of theoretical tools that can be used to understand the spin dynamics in large CSMs.

Effectiveness of complementary and self-help treatments for anxiety disorders.

Science.gov (United States)

Jorm, Anthony F; Christensen, Helen; Griffiths, Kathleen M; Parslow, Ruth A; Rodgers, Bryan; Blewitt, Kelly A

2004-10-04

To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders. Systematic literature search using PubMed, PsycLit, and the Cochrane Library. 108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies. The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.

Dosimetric Effects Of Different Treatment Tables During Radiotherapy

International Nuclear Information System (INIS)

Murkovic, M.; Grego, T.; Bibic, J.

2015-01-01

The aim of our study was to measure the effect of mega-voltage photon beam attenuation when treating patients through carbon fibre treatment table with and without the carbon laminate base plate on it. We also examined the ability of XiO treatment planning system in modelling this effect. Direct attenuation measurements were made for two treatment tables, Siemens TxT 550 treatment table with TT-A table top and Elekta Precise table with iBEAM evo table top. On both treatment tables we used Orfit Base Plate (32301). Measurements were taken for two photon energies (6 MV and 18 MV), at two different field sizes (5 x 5 cm 2 and 10 x 10 cm 2 ) and different gantry angles in 50 intervals using stationary water phantom and Farmer type ionization chamber. These values were compared to values calculated in XiO. In order to account for the effect of table and base plate during treatment planning in XiO, customized table and base plate templates were develop in Focal planning system. To construct these customized templates, table and base plate contours as well as respective relative electron density's to water were obtained on CT scanner. The largest attenuation effect was seen for oblique treatment angles using low energy and small field sizes, 6.6 percent for the Elekta table top and 8.4 percent for Siemens table top. In this paper we show that customized table and base plate templates introduced in the patient treatment plan can accurately model the attenuation due to their presence to within 0.3 percent. Since dose modifications due to such carbon fiber accessories can be significant, it can be concluded that introduction of customized table and base plate templates into TPS brings an important improvement to patient treatment planning, and should be included in dose calculations whenever possible. (author).

Effects of natalizumab treatment on Foxp3+ T regulatory cells.

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Max-Philipp Stenner

Full Text Available BACKGROUND: Natalizumab, a monoclonal humanized antibody targeting the alpha-4 chain of very late activation antigen 4 (VLA-4 exerts impressive therapeutic effects in patients with relapsing-remitting multiple sclerosis. Our objective was to study impacts of Natalizumab therapy on Foxp3+ T regulatory cells (Tregs in multiple sclerosis (MS patients. METHODOLOGY: A combined approach of in vitro and ex vivo experiments using T cells isolated from the peripheral blood of healthy donors and Natalizumab treated MS patients was chosen. We determined binding of Natalizumab and its effects on the frequency, transmigratory behaviour and suppressive function of Tregs. PRINCIPAL FINDINGS: Binding of Natalizumab and expression of CD49d (alpha-4 chain of VLA-4 differed between non-regulatory and regulatory cells. Albeit Foxp3+ Tregs had lower levels of CD49d, Natalizumab blocked the transmigration of Foxp3+ Tregs similar to non-regulatory T cells. The frequency of peripheral blood Tregs was unaffected by Natalizumab treatment. Natalizumab does not alter the suppressive capacity of CD4+CD25(highCD127(lowFoxp3+ Tregs under in vitro conditions. Furthermore, the impaired function of Tregs in MS patients is not restored by Natalizumab treatment. CONCLUSIONS: We provide a first detailed analysis of Natalizumab effects on the regulatory T cell population. Our prospective study shows that Foxp3+ Tregs express lower levels of VLA-4 and bind less Natalizumab. We further the understanding of the mechanisms of action of Natalizumab by demonstrating that unlike other immunomodulatory drugs the beneficial therapeutic effects of the monoclonal antibody are largely independent of alterations in Treg frequency or function.

Irradiation of 'carabao' (Manila 'super') mangoes II. Comparison of the effects of gamma radiation and the vapor heat treatment on fruit quality

International Nuclear Information System (INIS)

Lizada, M.C.C.; Esguerra, E.B.; Brena, S.R.; Fuentes, R.A.

1990-01-01

'Carabao' mango fruits subjected to gamma radiation at 100, 150 or 250 Gy resulted in fruits of an acceptable quality. In contrast to the vapor heat treatment, no internal breakdown was observed even in fruits irradiated at 350 Gy. At this dose a low but significant incidence of pulp discoloration was found, albeit in only one trial. Both the vapor heat treatment and gamma radiation need to be supplemented with hot water treatment for effective and more consistent disease control. Although irradiation appears to delay ripening, its effect seems to be largely on peel color development. The results of this study indicate that irradiation might be an appropriate quarantine treatment for the 'Carabao' mango. (Auth.). 7 tabs., 3 figs

The Effects of Deoxynivalenol and Zearalenone on the Pig Large Intestine. A Light and Electron Microscopy Study

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Barbara Przybylska-Gornowicz

2018-04-01

Full Text Available The contamination of feed with mycotoxins results in reduced growth, feed refusal, immunosuppression, and health problems. Deoxynivalenol (DON and zearalenone (ZEN are among the most important mycotoxins. The aim of the study was to examine the effects of low doses of these mycotoxins on the histological structure and ultrastructure of the large intestine in the pig. The study was performed on 36 immature gilts of mixed breed (White Polish Big × Polish White Earhanging, which were divided into four groups administrated per os with ZEN at 40 µg/kg BW, DON at 12 µg/kg BW, a mixture of ZEN (40 µg/kg BW and DON (12 µg/kg BW or a placebo. The pigs were killed by intravenous overdose of pentobarbital after one, three, and six weeks of treatment. The cecum, ascending and descending colon samples were prepared for light and electron microscopy. Administration of toxins did not influence the architecture of the mucosa and submucosa in the large intestine. ZEN and ZEN + DON significantly decreased the number of goblet cells in the cecum and descending colon. The mycotoxins changed the number of lymphocytes and plasma cells in the large intestine, which usually increased in number. However, this effect differed between the intestine segments and toxins. Mycotoxins induced some changes in the ultrastructure of the mucosal epithelium. They did not affect the expression of proliferative cell nuclear antigen and the intestinal barrier permeability. The obtained results indicate that mycotoxins especially ZEN may influence the defense mechanisms of the large intestine.

Identifying demand effects in a large network of product categories

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Gelper, S.E.C.; Wilms, I.; Croux, C.

2016-01-01

Planning marketing mix strategies requires retailers to understand within- as well as cross-category demand effects. Most retailers carry products in a large variety of categories, leading to a high number of such demand effects to be estimated. At the same time, we do not expect cross-category

Estimating the Effectiveness of Special Education Using Large-Scale Assessment Data

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Ewing, Katherine Anne

2009-01-01

The inclusion of students with disabilities in large scale assessment and accountability programs has provided new opportunities to examine the impact of special education services on student achievement. Hanushek, Kain, and Rivkin (1998, 2002) evaluated the effectiveness of special education programs by examining students' gains on a large-scale…

Neuroimaging in aphasia treatment research: Standards for establishing the effects of treatment

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Kiran, Swathi; Ansaldo, Ana; Bastiaanse, Roelien; Cherney, Leora R.; Howard, David; Faroqi-Shah, Yasmeen; Meinzer, Marcus; Thompson, Cynthia K

2012-01-01

The goal of this paper is to discuss experimental design options available for establishing the effects of treatment in studies that aim to examine the neural mechanisms associated with treatment-induced language recovery in aphasia, using functional magnetic resonance imaging (fMRI). We present both group and single-subject experimental or case-series design options for doing this and address advantages and disadvantages of each. We also discuss general components of and requirements for treatment research studies, including operational definitions of variables, criteria for defining behavioral change and treatment efficacy, and reliability of measurement. Important considerations that are unique to neuroimaging-based treatment research are addressed, pertaining to the relation between the selected treatment approach and anticipated changes in language processes/functions and how such changes are hypothesized to map onto the brain. PMID:23063559

SARS: systematic review of treatment effects.

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Lauren J Stockman

2006-09-01

Full Text Available BACKGROUND: The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO expert panel on SARS treatment requested a systematic review and comprehensive summary of treatments used for SARS-infected patients in order to guide future treatment and identify priorities for research. METHODS AND FINDINGS: In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r, type I interferon (IFN, intravenous immunoglobulin (IVIG, and SARS convalescent plasma from both in vitro studies and in SARS patients. We also searched for clinical trial evidence of treatment for acute respiratory distress syndrome. Sources of data were the literature databases MEDLINE, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials (CENTRAL up to February 2005. Data from publications were extracted and evidence within studies was classified using predefined criteria. In total, 54 SARS treatment studies, 15 in vitro studies, and three acute respiratory distress syndrome studies met our inclusion criteria. Within in vitro studies, ribavirin, lopinavir, and type I IFN showed inhibition of SARS-CoV in tissue culture. In SARS-infected patient reports on ribavirin, 26 studies were classified as inconclusive, and four showed possible harm. Seven studies of convalescent plasma or IVIG, three of IFN type I, and two of LPV/r were inconclusive. In 29 studies of steroid use, 25 were inconclusive and four were classified as causing possible harm. CONCLUSIONS: Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. Clinical trials should be designed to validate a standard protocol for dosage

Cost effectiveness of Tuberculosis Treatment from the Patients ...

African Journals Online (AJOL)

... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...

Impact of Treatment Integrity on Intervention Effectiveness

Science.gov (United States)

Fryling, Mitch J.; Wallace, Michele D.; Yassine, Jordan N.

2012-01-01

Treatment integrity has cogent implications for intervention effectiveness. Understanding these implications is an important, but often neglected, undertaking in behavior analysis. This paper reviews current research on treatment integrity in applied behavior analysis. Specifically, we review research evaluating the relation between integrity…

Effects of contact with treatment users on mental illness stigma: evidence from university roommate assignments.

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Eisenberg, Daniel; Downs, Marilyn F; Golberstein, Ezra

2012-09-01

Mental illness stigma refers to negative stereotypes and prejudices about people with mental illness, and is a widespread phenomenon with damaging social, psychological, and economic consequences. Despite considerable policy attention, mental illness stigma does not appear to have declined significantly in recent years. Interpersonal contact with persons with mental illness has been identified as a promising approach to reducing mental illness stigma. This study investigates the effect of contact with mental health treatment users on stigma using an observational research design that is free of self-selection bias. The research design is based on the quasi-experiment in which university students are assigned to live together as roommates. Survey data were collected from first-year undergraduates at two large universities in the United States (N = 1605). Multivariable regressions were used to estimate the effect of assignment to a roommate with a history of mental health treatment on a brief measure of stigmatizing attitudes. Contact with a treatment user caused a modest increase in stigma (standardized effect size = 0.15, p = 0.03). This effect was present among students without a prior treatment history of their own, but not among those with a prior history. The findings indicate that naturalistic contact alone does not necessarily yield a reduction in mental illness stigma. This may help explain why stigma has not declined in societies such as the United States even as treatment use has risen substantially. The findings also highlight the importance of isolating the specific components, beyond contact per se, that are necessary to reduce stigma in contact-based interventions. Copyright © 2012 Elsevier Ltd. All rights reserved.

Treatment failure of nelfinavir-containing triple therapy can largely be explained by low nelfinavir plasma concentrations

NARCIS (Netherlands)

Burger, David M.; Hugen, Patricia W. H.; Aarnoutse, Rob E.; Hoetelmans, Richard M. W.; Jambroes, Marielle; Nieuwkerk, Pythia T.; Schreij, Gerrit; Schneider, Margriet M. E.; van der Ende, Marchina E.; Lange, Joep M. A.

2003-01-01

The relationship between plasma concentrations of nelfinavir and virologic treatment failure was investigated to determine the minimum effective concentration of nelfinavir. Plasma samples were prospectively collected from treatment-naive patients who began taking nelfinavir, 1,250 mg BID + two

Cost-effectiveness analysis of optimal strategy for tumor treatment

International Nuclear Information System (INIS)

Pang, Liuyong; Zhao, Zhong; Song, Xinyu

2016-01-01

We propose and analyze an antitumor model with combined immunotherapy and chemotherapy. Firstly, we explore the treatment effects of single immunotherapy and single chemotherapy, respectively. Results indicate that neither immunotherapy nor chemotherapy alone are adequate to cure a tumor. Hence, we apply optimal theory to investigate how the combination of immunotherapy and chemotherapy should be implemented, for a certain time period, in order to reduce the number of tumor cells, while minimizing the implementation cost of the treatment strategy. Secondly, we establish the existence of the optimality system and use Pontryagin’s Maximum Principle to characterize the optimal levels of the two treatment measures. Furthermore, we calculate the incremental cost-effectiveness ratios to analyze the cost-effectiveness of all possible combinations of the two treatment measures. Finally, numerical results show that the combination of immunotherapy and chemotherapy is the most cost-effective strategy for tumor treatment, and able to eliminate the entire tumor with size 4.470 × 10"8 in a year.

Two horizontal rectus eye muscle surgery combined with botulinum toxin for the treatment of very large angle esotropia. A pilot study.

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Khan, Arif O

2005-01-01

To evaluate the effectiveness of a proposed new protocol for the primary treatment for very large angle esotropia: two muscle horizontal rectus muscle surgery with simultaneous botulinum toxin A injection in a small pilot study. Eight patients who had esotropia at near (ET') greater than 60 prism diopters (in actuality 70 to 100 prism diopters ET') underwent 2 muscle horizontal rectus surgery with simultaneous botulinum toxin A injection of the medial rectus intraoperatively. This was the only surgical procedure for all patients included in this report. Seven patients underwent bilateral medial rectus recession and bilateral injection, and one patient underwent a unilateral medial rectus recession / lateral rectus resection procedure with unilateral medial rectus injection. Postoperatively, 6 of the 8 patients demonstrated residual esotropia at near of less than 10 prism diopters and were considered "successful" by the conventional criteria of binocular alignment within 8 prism diopters of orthotropia. Two undercorrections occurred in patients with 100 and 85 prism diopters of preop ET' respectively. But 3 other patients with such large deviations had satisfactory results. All patients and families were satisfied with postoperative binocular alignment, so no further surgery was undertaken. The patient who underwent unilateral surgery had the least surgical effect and was the largest undercorrection, probably because only one medial rectus received a Botox injection. Considering only the bilateral cases, results were "successful" in 6 of 7 cases. Most patients suffered an extended period of Botox induced exotropia in the postop' period before recovery from the paresis. One patient had a transient, successfully treated, postoperative strabismic amblyopia while exotropic. Bilateral medial rectus recession with simultaneous botulinum injection is a safe and effective primary surgical procedure for very large angle esotropia. A more extensive study is indicated to

Effect of short-term intensive atorvastatin treatment on interventional treatment effect and cardiac function of patients with acute coronary syndrome

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Yu Lei

2016-06-01

Full Text Available Objective: To study the effect of short-term intensive atorvastatin treatment on interventional treatment effect and cardiac function of patients with acute coronary syndrome. Methods: A total of 104 cases of patients with acute coronary syndrome who received PCI treatment in Emergency Department of our hospital from May 2014 to November 2015 were retrospectively analyzed and divided into intensive group and routine group according to different atorvastatin treatment methods, and then biochemical indexes, cardiac ultrasound indicators and inflammatory indexes of two groups were compared. Results: Serum TG, TC, LDL-C, hs- CRP, LDH, α-HBDH, CK and CK-MB content of intensive group were significantly lower than those of routine group while HDL-C content was higher than that of routine group; E/ A ratio and LVEF of intensive group were higher than those of routine group while Tei index, systolic index and diastolic index were lower than those of routine group; TLR4 and NF-kB expression levels in peripheral blood as well as TNF-α and IL-6 content in serum of intensive group were significantly lower than those of routine group. Conclusion: Short-term intensive atorvastatin treatment improves the interventional treatment effect of patients with acute coronary syndrome, and can reduce myocardial injury, improve cardiac diastolic and systolic function and inhibit the inflammation mediated by TLR4/NF-kB.

Effects of chronic estradiol treatment on the thyroid gland structure and function of ovariectomized rats

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Elgendy Mohamed S

2009-08-01

Full Text Available Abstract Background Estrogen therapy is widely used nowadays in women to treat many postmenopausal symptoms but it may have some undesirable effects due to multiple organs affection. So, the aim of this study was to determine the effects of chronic estradiol treatment on the structure and function of the thyroid gland in ovarictomized rats as a model simulating menopause. Findings Thirty adult female Wistar rats divided into three groups were used in this study; the first group was sham-operated, while the second and third groups were ovariectomized. The first and second groups were injected with olive oil while the third group was injected with estradiol dipropionate daily for three months, after that; hormonal assay for T3, T4, TSH and specimens of the thyroid were taken and processed to be examined by light and electron microscopy. The results of this study revealed that serum levels of T3 and T4 decreased in ovariectomized animals and significantly increased after estradiol treatment, while TSH increased in ovariectomized animals and decreased with estradiol treatment. Histological and morphometric study in ovariectomized group revealed marked accumulation of colloid in follicular lumens with decreased epithelial height in addition to increased connective tissue amount. After estradiol treatment the follicles became smaller in size, having small amount of colloid with increased epithelial height in addition to decreased connective tissue content. Ultrastructural study supported these results in addition to the presence of large amount of intracytoplasmic colloid vesicles after estradiol treatment. Conclusion Low estrogen level may lead to mild thyroidal hypofunction while estradiol treatment may lead to hyperactivity so it should be used very cautiously in the treatment of postmenopausal symptoms to avoid its undesirable stimulatory effect on the thyroid.

The effectiveness of online cognitive behavioral treatment in routine clinical practice.

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Jeroen Ruwaard

Full Text Available Randomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders.To assess the effectiveness of online CBT for different mental disorders in routine clinical practice.An uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up.1500 adult patients (female: 67%; mean age: 40 years with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413, panic disorder (n = 139, posttraumatic stress (n = 478, or burnout (n = 470.Manualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress to 16 weeks (online CBT for Depression.Validated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales.Treatment adherence was 71% (n = 1071. Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9±0.2 to d = 1.2±0.2; P<.001, which sustained up to one year after treatment. At posttest, rates of reliable improvement and recovery were 71% and 52% in the completer sample (full sample: 55%/40%. Patient satisfaction was high.Results suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.

Adverse effects of orthodontic treatment: A clinical perspective

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Talic, Nabeel F.

2011-01-01

Orthodontic treatment is associated with a number of adverse effects, such as root resorption, pain, pulpal changes, periodontal disease, and temporomandibular dysfunction (TMD). Orthodontists should be aware of these effects and associated risk factors. Risk factors linked to root resorption include the duration of treatment, length, and shape of the root, trauma history, habits, and genetic predisposition. PMID:24151415

Effectiveness of an intensive multidisciplinary headache treatment program.

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Gunreben-Stempfle, Birgit; Griessinger, Norbert; Lang, Eberhard; Muehlhans, Barbara; Sittl, Reinhard; Ulrich, Kathrin

2009-07-01

To investigate if the effectiveness of a 96-hour multidisciplinary headache treatment program exceeds the effectiveness of a 20-hour program and primary care. When dealing with chronic back pain, low-intensity multidisciplinary treatment yields no significantly better results than standard care and monodisciplinary therapy; however, high-intensity treatment does. For multidisciplinary headache treatment, such comparisons are not yet available. In a previous study undertaken by our Pain Center, the outcome of a minimal multidisciplinary intervention model (20-hour) did not exceed primary care. Forty-two patients suffering from frequent headaches (20 +/- 9 headache days/month; range: 8-30) were treated and evaluated in a 96-hour group program. The results were compared with the outcomes of the previous study. Subjects who had undergone either the 20-hour multidisciplinary program or the primary care were used as historical control groups. A significant reduction in migraine days (P tension-type headache days (P tension-type headache days (P = .016), and frequency of migraine attacks (P = .016). In comparison with the 20-hour multidisciplinary program, the 96-hour program showed significantly better effects only in the reduction of migraine days (P = .037) and depression score (P = .003). The responder-rates (> or =50% improvement) in the 96-hour program were significantly higher than in the 20-hour program (migraine days, P = .008; tension-type headache days, P = .044) and primary care (migraine days, P = .007; tension-type headache days, P = .003; tension-type headache intensity, P = .037). The effect sizes were small to medium in the 96-hour program. Particularly with the reduction of migraine symptomatology, the 96-hour program performed better than the 20-hour program, which produced only negligible or small effects. Intensive multidisciplinary headache treatment is highly effective for patients with chronic headaches. Furthermore, migraine symptomatology

Gemcitabine and treatment of diffuse large B-cell lymphoma in relapsed or refractory elderly patients: A prospective randomized trial in Algeria

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Aribi Mourad

2010-01-01

Full Text Available Context: Support for non-Hodgkin′s lymphoma (NHL with large cells that is refractory or relapsed after first-line chemotherapy poses a greater therapeutic problem with bone marrow transplant therapy or when old age is a contra-indication for high-dose chemotherapy, especially among developing countries such as Algeria. Aim: To show that the regimen, including gemcitabine, could be more effective in treating elderly patients with diffuse large B-cell lymphoma (DLBCL in relapse / refractory, without complete remission, when compared with the ESHAP (etoposide, cisplatine, solumedrol, aracytine regimen. Materials and Methods: Ninety-six patients in the age group of 60-70 years were volunteers for a prospective randomized single-blind study, carried out for three years. Patients were divided into two groups by the drawing of lots. The first group (GA, n = 48, relapse; n = 27 [56.3%], refractory; n = 21 [43.7%] received treatment with ESHAP protocol and the second one (GB, n = 48, relapse; n = 28 [58%], refractory; n = 20 [42%] with GPD (gemcitabine, dexamethasone, cisplatine protocol. Results: The overall response rates and mean survival at three years were significantly higher among patients subjected to GPD treatment compared with those subjected to ESHAP treatment (63% vs. 55%, P = 0.01 and 20.5% [95% CI 16.5-24.5] vs. 11.8% [8.9-14.6], respectively. Additionally, three-year progression-free and event-free survival rates were 20.5% (16.3-24 and 19.7% (15.9-23.5, respectively, for the GPD regimen and 10.9% (8.2-13.7 and 11.1% (95% CI 8.5-13.7, respectively, for the ESHAP regimen. Moreover, the GPD regimen was associated with improving overall survival (RR=2.02, 95% CI 1.59-2.56; P = 0.000, event-free survival (2.03, 1.64-2.52; P < 0.001 and progression-free survival (1.86, 1.46-2.37; P < 0.001. Conclusion: In cases of contra-indication for high-dose chemotherapy for elderly patients with DLBCL, without complete remission, the Gemcitabine

Rituximab plus chemotherapy as first-line treatment in Chinese patients with diffuse large B-cell lymphoma in routine practice: a prospective, multicentre, non-interventional study

International Nuclear Information System (INIS)

Wu, Jianqiu; Song, Yongping; Su, Liping; Xu, Li; Chen, Tingchao

2016-01-01

The efficacy and safety of rituximab-based chemotherapy (R-chemo), the standard regimen for patients with diffuse large B-cell lymphoma (DLBCL), which is more common in Asia than in Western countries, are well confirmed in randomized controlled trials (RCTs). However, the safety and effectiveness of R-chemo in patients who are largely excluded from RCTs have not been well characterized. This real-world study investigated the safety and effectiveness of R-chemo as first-line treatment in Chinese patients with DLBCL. Treatment-naive DLBCL patients who were CD20 positive and eligible to receive R-chemo were enrolled with no specific exclusion criteria. Data collected at baseline included age, gender, disease stage, international prognostic index (IPI), B symptoms, extranodal involvement, performance status, and medical history. In the present study, data on safety, treatment effectiveness, and HBV infection management were collected 120 days after the last R-chemo administration. Overall, R-chemo was well tolerated. The safety profile of R-chemo in patients with a history of heart or liver disease was well described without any additional unexpected safety concerns. The overall response rate (ORR) in the Chinese patients from this study was 94.2 % (complete response [CR], 55.0 %; CR unconfirmed [CRu] 18.2 %; and partial response [PR], 20.9 %). Compared to patients with no history of disease, the CR and PR rates of patients with a history of heart or liver disease were lower and higher, respectively; this tendency could be in part explained by treatment interruptions in patients with heart or liver diseases. HBsAg positivity and a maximum tumor diameter of ≥7.5 cm negatively correlated with CR + CRu, whereas age and HBsAg positivity negatively correlated with CR. This study further validated the safety and effectiveness of R-chemo in Chinese patients with DLBCL. Patients with a history of heart or liver disease may further benefit from R-chemo if preventive measures

Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects

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Kenter Robin

2013-01-01

Full Text Available Abstract Background Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center. Methods We studied all 104 consecutive patients aged 18–65 years with elevated symptoms of depression, anxiety and/or burnout who registered at the center during the first six months after implementation. They were offered a five week guided online treatment. At baseline, five weeks and twelve weeks we measured depressive (BDI-II, anxiety (HADS-A and burnout symptoms (MBI. Results A total of 55 patients (53% agreed to start with the online treatment. Patients who accepted the online treatment were more often female, younger and lower educated than those who refused. There were no baseline differences in clinical symptoms between the groups. There were large between group effect sizes after five weeks for online treatment for depression (d = 0.94 and anxiety (d = 1.07, but not for burnout (d = −.07. At twelve weeks, when both groups had started regular face-to-face treatments, we no longer found significant differences between the groups, except for anxiety (d = 0.69. Conclusion The results of this study show that the majority of patients prefer online guided online treatment instead of waiting for face-to-face treatment. Furthermore, online PST increases speed of recovery and can therefore be offered as a first step of treatment in mental healthcare.

Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

International Nuclear Information System (INIS)

Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben; Pratt, Steven; Schenk, Peer M.

2014-01-01

Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

Comparative effects of biomass pre-treatments for direct and indirect transesterification to enhance microalgal lipid recovery

Directory of Open Access Journals (Sweden)

Forough eGhasemi Naghdi

2014-12-01

Full Text Available Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane-ethanol (3:1. Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171% under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

Energy Technology Data Exchange (ETDEWEB)

Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia); Pratt, Steven [School of Chemical Engineering, The University of Queensland, Brisbane, QLD (Australia); Schenk, Peer M., E-mail: p.schenk@uq.edu.au [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia)

2014-12-04

Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

Observations on the Prevalence, Characteristics, and Effects of Self-Treatment

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Shuangge eMa

2016-04-01

Full Text Available Aims: When facing illness, a person may choose self-treatment as an alternative to hospital (and primary care-based treatment. Despite its important role in healthcare, the study on self-treatment remains limited. The goal is to collectively report the observations in the literature on the prevalence, characteristics, and effects of self-treatment.Methods: Extensive literature search was conducted, and relevant information was extracted.Results: Published studies have reported that in some regions, the prevalence of self-treatment is high and varies across illness conditions and treatment approaches. Self-medication is the most popular self-treatment approach. Multiple regional, demographic, personal, cultural and religious factors have been implicated in the pursuit of self-treatment. In addition, accessibility of healthcare also plays a role. Self-treatment in general has a positive clinical and financial effect. However there have been concerns on abuse and possible negative effects. Conclusions: This article reviews observations made in recent studies on several important aspects of self-treatment. Comprehensive and systematic study is still lacking. Interventions are needed to solve several problems associated with self-treatment.

A Novel Treatment of Fear of Flying Using a Large Virtual Reality System.

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Czerniak, Efrat; Caspi, Asaf; Litvin, Michal; Amiaz, Revital; Bahat, Yotam; Baransi, Hani; Sharon, Hanania; Noy, Shlomo; Plotnik, Meir

2016-04-01

Fear of flying (FoF), a common phobia in the developed world, is usually treated with cognitive behavioral therapy, most efficiently when combined with exposure methods, e.g., virtual reality exposure therapy (VRET). We evaluated FoF treatment using VRET in a large motion-based VR system. The treated subjects were seated on a moving platform. The virtual scenery included the interior of an aircraft and a window view to the outside world accompanied by platform movements simulating, e.g., takeoff, landing, and air turbulence. Relevant auditory stimuli were also incorporated. Three male patients with FoF underwent a clinical interview followed by three VRETs in the presence and with the guidance of a therapist. Scores on the Flight Anxiety Situation (FAS) and Flight Anxiety Modality (FAM) questionnaires were obtained on the first and fourth visits. Anxiety levels were assessed using the subjective units of distress (SUDs) scale during the exposure. All three subjects expressed satisfaction regarding the procedure and did not skip or avoid any of its stages. Consistent improvement was seen in the SUDs throughout the VRET session and across sessions, while patients' scores on the FAS and FAM showed inconsistent trends. Two patients participated in actual flights in the months following the treatment, bringing 12 and 16 yr of avoidance to an end. This VR-based treatment includes critical elements for exposure of flying experience beyond visual and auditory stimuli. The current case reports suggest VRET sessions may have a meaningful impact on anxiety levels, yet additional research seems warranted.

Estimation and Inference for Very Large Linear Mixed Effects Models

OpenAIRE

Gao, K.; Owen, A. B.

2016-01-01

Linear mixed models with large imbalanced crossed random effects structures pose severe computational problems for maximum likelihood estimation and for Bayesian analysis. The costs can grow as fast as $N^{3/2}$ when there are N observations. Such problems arise in any setting where the underlying factors satisfy a many to many relationship (instead of a nested one) and in electronic commerce applications, the N can be quite large. Methods that do not account for the correlation structure can...

Outcome analysis of 250 cases of Graves disease with large goiter treated with 131I

International Nuclear Information System (INIS)

Wang Qinfen; Zhang Chenggang; Zhao Xiaobin; Shi Longbao

2003-01-01

Objective: To evaluate the treatment effects of Graves disease with large goiter treated with 131 I and the method of 131 I individualized estimated dose. Methods: Two hundred and fifty patients with Graves disease with large goiter (mean of thyroid weight 113.0 ± 39.2 g; range 90-450 g) were studied according to patient individual factors, the dose per g thyroid tissue ranging from 2. 775-5.18 MBq/g was determined, then the administered dose was calculated using the special formula. The follow-up was for 15.9 ± 9.9 (range 3-44.7) months. Results: After one dose of 131 I, 154 patients (61.6%) became euthyroid, 53 patients (21.2%) remained to be hyperthyroidism, 43 patients (17.2%) became hypothyroidism. Large goiter in 219 patients (87.6%) was normalized. Conclusions: Treatment with 131 I is an effective method for Graves disease with large goiter; According to factors affecting outcome, employing the method of individualized radioiodine therapy can improve the efficacy of 131 I treatment

Large Scale Obscuration and Related Climate Effects Workshop: Proceedings

Energy Technology Data Exchange (ETDEWEB)

Zak, B.D.; Russell, N.A.; Church, H.W.; Einfeld, W.; Yoon, D.; Behl, Y.K. [eds.

1994-05-01

A Workshop on Large Scale Obsurcation and Related Climate Effects was held 29--31 January, 1992, in Albuquerque, New Mexico. The objectives of the workshop were: to determine through the use of expert judgement the current state of understanding of regional and global obscuration and related climate effects associated with nuclear weapons detonations; to estimate how large the uncertainties are in the parameters associated with these phenomena (given specific scenarios); to evaluate the impact of these uncertainties on obscuration predictions; and to develop an approach for the prioritization of further work on newly-available data sets to reduce the uncertainties. The workshop consisted of formal presentations by the 35 participants, and subsequent topical working sessions on: the source term; aerosol optical properties; atmospheric processes; and electro-optical systems performance and climatic impacts. Summaries of the conclusions reached in the working sessions are presented in the body of the report. Copies of the transparencies shown as part of each formal presentation are contained in the appendices (microfiche).

Cost-effectiveness in Clostridium difficile treatment decision-making.

Science.gov (United States)

Nuijten, Mark Jc; Keller, Josbert J; Visser, Caroline E; Redekop, Ken; Claassen, Eric; Speelman, Peter; Pronk, Marja H

2015-11-16

To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection (CDI). CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines. A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.

Therapeutic strategy with artificially-designed i-lncRNA targeting multiple oncogenic microRNAs exhibits effective antitumor activity in diffuse large B-cell lymphoma.

Science.gov (United States)

Su, Yinghan; Sun, Bin; Lin, Xuejing; Zhao, Xinying; Ji, Weidan; He, Miaoxia; Qian, Haihua; Song, Xianmin; Yang, Jianmin; Wang, Jianmin; Chen, Jie

2016-08-02

In diffuse large B-cell lymphoma (DLBCL), many oncogenic microRNAs (OncomiRs) are highly expressed to promote disease development and progression by inhibiting the expression and function of certain tumor suppressor genes, and these OncomiRs comprise a promising new class of molecular targets for the treatment of DLBCL. However, most current therapeutic studies have focused on a single miRNA, with limited treatment outcomes. In this study, we generated tandem sequences of 10 copies of the complementary binding sequences to 13 OncomiRs and synthesized an interfering long non-coding RNA (i-lncRNA). The highly-expressed i-lncRNA in DLBCL cells would compete with the corresponding mRNAs of OncomiR target genes for binding OncomiRs, thereby effectively consuming a large amount of OncomiRs and protecting many tumor suppressor genes. The in vitro experiments confirmed that the i-lncRNA expression significantly inhibited cell proliferation, induced cell cycle arrest and apoptosis in DLBCL cell lines, mainly through upregulating the expression of PTEN, p27kip1, TIMP3, RECK and downregulating the expression of p38/MAPK, survivin, CDK4, c-myc. In the established SUDHL-4 xenografts in nude mice, the treatment strategy involving adenovirus-mediated i-lncRNA expression significantly inhibited the growth of DLBCL xenografts. Therefore, this treatment would specifically target the carcinogenic effects of many OncomiRs that are usually expressed in DLBCL and not in normal cells, such a strategy could improve anti-tumor efficacy and safety and may be a good prospect for clinical applications.

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study).

Science.gov (United States)

van den Broek, Frank J C; de Graaf, Eelco J R; Dijkgraaf, Marcel G W; Reitsma, Johannes B; Haringsma, Jelle; Timmer, Robin; Weusten, Bas L A M; Gerhards, Michael F; Consten, Esther C J; Schwartz, Matthijs P; Boom, Maarten J; Derksen, Erik J; Bijnen, A Bart; Davids, Paul H P; Hoff, Christiaan; van Dullemen, Hendrik M; Heine, G Dimitri N; van der Linde, Klaas; Jansen, Jeroen M; Mallant-Hent, Rosalie C H; Breumelhof, Ronald; Geldof, Han; Hardwick, James C H; Doornebosch, Pascal G; Depla, Annekatrien C T M; Ernst, Miranda F; van Munster, Ivo P; de Hingh, Ignace H J T; Schoon, Erik J; Bemelman, Willem A; Fockens, Paul; Dekker, Evelien

2009-03-13

Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM). If equally effective, EMR might be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications.The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma > or = 3 cm, located between 1-15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2) number of days not spent in hospital from initial treatment until 2 years afterwards; 3) major and minor morbidity; 4) disease specific and general quality of life; 5) anorectal function; 6) health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR of 3.3% and considering an upper-limit of 10

Contemporary conceptions of etiology, pathogenesis, management and treatment of primary diffuse large b-cell central nervous system lymphoma

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S. V. Voloshin

2013-01-01

Full Text Available In this article we present the most up-to-date information about etiology, pathogenesis, diagnostic and treatment principles of primary central nervous system diffuse large B-cell lymphoma. We propose algorithm of diagnosis and treatment based on literature review and own experience. The main methods for diagnosis verification are magneto-resonance tomography and stereotactic biopsy of mass with subsequent histological examination including immune staining. The common first-line therapy regimen is high-dose methotrexate therapy. However long-term prognosis still remains poor. Adverse prognostic factors for therapy response are age > 60 years, multifocal lesions, neurologic symptoms,previous treated disease. Considerable part of patient have contraindications or high-risk of adverse events for high-dose chemotherapy treatment. Anti-CD20 monoclonal antibody has no neurological toxicity with intravenous and intrathecal administrations. Combination therapy with reduced dose methotrexate and monoclonal antibody can be a reasonable treatment alternative for old and disable persons. The further survival improvement would be achieved by patient stratification and using of risk-adapted treatment algorithm. 

Contemporary conceptions of etiology, pathogenesis, management and treatment of primary diffuse large b-cell central nervous system lymphoma

Directory of Open Access Journals (Sweden)

S. V. Voloshin

2014-07-01

Full Text Available In this article we present the most up-to-date information about etiology, pathogenesis, diagnostic and treatment principles of primary central nervous system diffuse large B-cell lymphoma. We propose algorithm of diagnosis and treatment based on literature review and own experience. The main methods for diagnosis verification are magneto-resonance tomography and stereotactic biopsy of mass with subsequent histological examination including immune staining. The common first-line therapy regimen is high-dose methotrexate therapy. However long-term prognosis still remains poor. Adverse prognostic factors for therapy response are age > 60 years, multifocal lesions, neurologic symptoms,previous treated disease. Considerable part of patient have contraindications or high-risk of adverse events for high-dose chemotherapy treatment. Anti-CD20 monoclonal antibody has no neurological toxicity with intravenous and intrathecal administrations. Combination therapy with reduced dose methotrexate and monoclonal antibody can be a reasonable treatment alternative for old and disable persons. The further survival improvement would be achieved by patient stratification and using of risk-adapted treatment algorithm. 

Is cannabis an effective treatment for joint pain?

Science.gov (United States)

Miller, Richard J; Miller, Rachel E

2017-01-01

Cannabis has been used to treat pain for thousands of years. However, since the early part of the 20th century, laws restricting cannabis use have limited its evaluation using modern scientific criteria. Over the last decade, the situation has started to change because of the increased availability of cannabis in the United States for either medical or recreational purposes, making it important to provide the public with accurate information as to the effectiveness of the drug for joint pain among other indications. The major psychotropic component of cannabis is Δ9-tetrahydrocannabinol (THC), one of some 120 naturally occurring phytocannabinoids. Cannabidiol (CBD) is another molecule found in herbal cannabis in large amounts. Although CBD does not produce psychotropic effects, it has been shown to produce a variety of pharmacological effects. Hence, the overall effects of herbal cannabis represent the collective activity of THC, CBD and a number of minor components. The action of THC is mediated by two major G-protein coupled receptors, cannabinoid receptor type 1 (CB1) and CB2, and recent work has suggested that other targets may also exist. Arachidonic acid derived endocannabinoids are the normal physiological activators of the two cannabinoid receptors. Natural phytocannabinoids and synthetic derivatives have produced clear activity in a variety of models of joint pain in animals. These effects are the result of both inhibition of pain pathway signalling (mostly CB1) and anti-inflammatory effects (mostly CB2). There are also numerous anecdotal reports of the effectiveness of smoking cannabis for joint pain. Indeed, it is the largest medical request for the use of the drug. However, these reports generally do not extend to regulated clinical trials for rheumatic diseases. Nevertheless, the preclinical and human data that do exist indicate that the use of cannabis should be taken seriously as a potential treatment of joint pain.

EFFECTS OF LARGE-SCALE POULTRY FARMS ON AQUATIC MICROBIAL COMMUNITIES: A MOLECULAR INVESTIGATION.

Science.gov (United States)

The effects of large-scale poultry production operations on water quality and human health are largely unknown. Poultry litter is frequently applied as fertilizer to agricultural lands adjacent to large poultry farms. Run-off from the land introduces a variety of stressors into t...

Projection Effects of Large-scale Structures on Weak-lensing Peak Abundances

Science.gov (United States)

Yuan, Shuo; Liu, Xiangkun; Pan, Chuzhong; Wang, Qiao; Fan, Zuhui

2018-04-01

High peaks in weak lensing (WL) maps originate dominantly from the lensing effects of single massive halos. Their abundance is therefore closely related to the halo mass function and thus a powerful cosmological probe. However, besides individual massive halos, large-scale structures (LSS) along lines of sight also contribute to the peak signals. In this paper, with ray-tracing simulations, we investigate the LSS projection effects. We show that for current surveys with a large shape noise, the stochastic LSS effects are subdominant. For future WL surveys with source galaxies having a median redshift z med ∼ 1 or higher, however, they are significant. For the cosmological constraints derived from observed WL high-peak counts, severe biases can occur if the LSS effects are not taken into account properly. We extend the model of Fan et al. by incorporating the LSS projection effects into the theoretical considerations. By comparing with simulation results, we demonstrate the good performance of the improved model and its applicability in cosmological studies.

Parent perspectives on information about late effects of childhood cancer treatment and their role in initial treatment decision making.

Science.gov (United States)

Greenzang, Katie A; Dauti, Angela; Mack, Jennifer W

2018-06-01

Though most childhood cancer survivors experience late effects of treatment, we know little about parent preferences for late effects information during therapy, or how parents weigh late effects when making treatment decisions. Our objective was to explore how parents of children with cancer consider late effects in initial treatment decision making and during active cancer treatment. Semistructured interviews were conducted with 12 parents of children with cancer who were actively receiving treatment at Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Interviews were audio-recorded, transcribed verbatim, and qualitatively analyzed using thematic analysis. Ten of 12 parents reported that they had to decide between two or more treatment options for their child's cancer. Of those, 50% (5/10) considered late effects to be an important factor in their decision making. Most parents wanted early and detailed information about their child's risk of late effects to make treatment decisions and to feel prepared for the future. However, a few parents felt too overwhelmed to focus on late effects at diagnosis. While many recalled extensive late effects information in informed consent discussions, some parents felt these issues were minimally addressed. Parents desire detailed information about late effects to make informed treatment decisions and prepare for the future. Despite the role of late effects in treatment decision making, some parents feel that late effects are either inadequately addressed or too overwhelming to process at diagnosis. Parents may benefit from early assessment of their information needs and a return to these issues over time. © 2018 Wiley Periodicals, Inc.

Moving effective treatment for posttraumatic stress disorder to primary care: A randomized controlled trial with active duty military.

Science.gov (United States)

Cigrang, Jeffrey A; Rauch, Sheila A; Mintz, Jim; Brundige, Antoinette R; Mitchell, Jennifer A; Najera, Elizabeth; Litz, Brett T; Young-McCaughan, Stacey; Roache, John D; Hembree, Elizabeth A; Goodie, Jeffrey L; Sonnek, Scott M; Peterson, Alan L

2017-12-01

Many military service members with PTSD do not receive evidence-based specialty behavioral health treatment because of perceived barriers and stigma. Behavioral health providers in primary care can deliver brief, effective treatments expanding access and reducing barriers and stigma. The purpose of this randomized clinical trial was to determine if a brief cognitive-behavior therapy delivered in primary care using the Primary Care Behavioral Health model would be effective at reducing PTSD and co-occurring symptoms. A total of 67 service members (50 men, 17 women) were randomized to receive a brief, trauma-focused intervention developed for the primary care setting called Prolonged Exposure for Primary Care (PE-PC) or a delayed treatment minimal contact control condition. Inclusion criteria were significant PTSD symptoms following military deployment, medication stability, and interest in receiving treatment for PTSD symptoms in primary care. Exclusion criteria were moderate or greater risk of suicide, severe brain injury, or alcohol/substance use at a level that required immediate treatment. Assessments were completed at baseline, posttreatment/postminimal contact control, and at 8-week and 6-month posttreatment follow-up points. Primary measures were the PTSD Symptom Scale-Interview and the PTSD Checklist-Stressor-Specific. PE-PC resulted in larger reduction in PTSD severity and general distress than the minimal contact control. Delayed treatment evidenced medium to large effects comparable to the immediate intervention group. Treatment benefits persisted through the 6-month follow-up of the study. PE-PC delivered in integrated primary care is effective for the treatment of PTSD and co-occurring symptoms and may help reduce barriers and stigma found in specialty care settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Adoption of endovenous laser treatment as the primary treatment modality for varicose veins: the Auckland City Hospital experience.

Science.gov (United States)

Fernando, Ruchira S W; Muthu, Carl

2014-08-01

To assess the effectiveness of adopting endovenous laser treatment (EVLT) as the primary treatment modality for varicose veins at Auckland City Hospital (Auckland, New Zealand). The outcomes of 354 consecutive EVLT procedures performed between 2007 and 2013 were reviewed. Data was collected from a prospectively maintained procedural database and by retrospective chart review. Of the 319 patients who had an ultrasound, at 1 month post-procedure there was a saphenous vein occlusion rate of 96%. Side effects were minimal with no cases of DVT or skin burns and one case of self-limiting neuralgia. The procedure was well tolerated with a median pain score of 3. Since the adoption of EVLT there has been a large increase in the number of patients treated for varicose veins (28 in 2007 compared to 176 in 2013). EVLT is a safe and effective treatment for varicose veins and its adoption has allowed a large increase in the number of varicose vein patients treated at Auckland City Hospital.

Dental Fear and Avoidance in Treatment Seekers at a Large, Urban Dental Clinic.

Science.gov (United States)

Heyman, Richard E; Slep, Amy M Smith; White-Ajmani, Mandi; Bulling, Lisanne; Zickgraf, Hana F; Franklin, Martin E; Wolff, Mark S

2016-01-01

The prevalence and correlates of dental fear have been studied in representative population studies, but not in patients presenting for dental treatment. We hypothesized that dental fear among patients presenting at a large, urban college of dentistry would be similar to that of the population (e.g. 11% high dental fear, 17% to 35% moderate or higher fear) and that fear would be associated with avoidance of routine dental care, increased use of urgent dental care and poor oral health. Participants were 1070 consecutive patients at a large, urban dental care center. All patients completed a clinical interview, including demographics, medical history, dental history and presenting concerns, and behavioral health history. Patients were also asked to rate their dental anxiety/fear on a 1 (none) to 10 (high) scale. Over 20% of patients reported elevated anxiety/fear, of which 12.30% reported moderate and 8.75% high fear. Severity of dental anxiety/fear was strongly related to the likelihood of avoiding dental services in the past and related to myriad presenting problems. As hypothesized, the prevalence of moderate or higher fear in dental patients was considerable and closely matched that found in general population surveys. Thus, the 'dental home' is an ideal location to treat clinically significant dental anxiety/fear.

Endometritis treatment with a PGF2alpha analog does not improve reproductive performance in a large dairy herd in Argentina.

Science.gov (United States)

Mejía, Miguel Eduardo; Lacau-Mengido, Isabel María

2005-03-15

In Argentina, most dairy cows with endometritis are treated with prostaglandin (PGF(2alpha) or its analogs) and insemination is withheld until there are no signs of endometritis. The objective of the present study was to evaluate if this method of managing endometritis enhances reproductive performance. Three experiments were conducted over 4 years in a large farm in the west of Buenos Aires province. In Experiment 1, half of the cows diagnosed with endometritis (>1.5-fold difference in diameter of uterine horns, as determined by rectal palpation) received standard endometritis management (treatment with tiaprost, a PGF(2alpha) analog, rectal palpation every 20 days, and withholding of AI until endometritis apparently resolved) and the other half was untreated, with AI at the first estrus after the voluntary waiting period. Untreated cows were inseminated and conceived 20 days earlier than treated cows, and the pregnancy rate by Day 90 postpartum was higher in the untreated group. In Experiment 2, cows with endometritis were divided into four groups according to the severity of symptoms; within each group, cows were allocated to treatment or control, as in Experiment 1. Although first service conception rate decreased as endometritis severity increased, reproductive performance in treated versus control cows was similar to that of Experiment 1 (with no interaction due to degree of endometritis). Re-evaluation of the treated cow (to confirm uterine "normality") may have been responsible for the delay in conception in both experiments. The objective of Experiment 3 was to determine the effects of tiaprost treatment on clinically normal postpartum cows (no evidence of endometritis). Tiaprost treatment reduced the interval from calving to conception in multiparous cows, but it delayed conception and reduced the conception rate in primiparous cows. In conclusion, treatment with tiaprost impaired reproductive performance in primiparous cows (in the absence of

Alternate day treatment and late effects: The concept of an effective dose per fraction

International Nuclear Information System (INIS)

Courdi, A.; Hery, M.; Gabillat, J.M.

1990-01-01

Although most institutions treat all fields each day, some radiotherapists continue to adopt an alternate day schedule. The resulting daily variations of the dose per fraction in laterally located targets have been analyzed using the linear-quadratic model. Patients with breast carcinoma treated with definitive radiotherapy in 1974-1975 with one field a day were studied. An effective dose per fraction was derived, with a value higher than the average dose per fraction received by the reference point. The greater the fluctuations between the doses per fraction on successive days, the higher the effective dose per fraction. The corresponding cell survival due to alternate treatment as compared to survival with daily treatment depends on the alpha/beta ratio. For a late effect with low alpha/beta ratio, an alternate treatment may lead to almost 10-fold increase in cell kill in these lateral targets such as those responsible for subcutaneous sclerosis as compared to daily treatment of all fields with the same total dose. Taking the average effective dose per fraction in our series, the increase in cell kill was 4-fold. Acute effects would suffer less damage due to alternate treatment because of a high alpha/beta ratio. Treatment on an alternate schedule should be restricted to palliative radiotherapy

The cost-effectiveness of IVF in the UK: a comparison of three gonadotrophin treatments.

Science.gov (United States)

Sykes, D; Out, H J; Palmer, S J; van Loon, J

2001-12-01

The objective of this study was to evaluate the cost-effectiveness of women undergoing IVF treatment with recombinant FSH (rFSH) in comparison with highly purified urinary FSH (uFSH-HP) and human menopausal gonadotrophins (HMG). A decision-analytic model was used to estimate cost-effectiveness ratios for 'the average cost per ongoing pregnancy' and 'incremental cost per additional pregnancy' for women entering into IVF treatment for a maximum of three cycles. The model was constructed based on a previously published large prospective randomized clinical trial comparing rFSH and uFSH-HP. Where necessary, these data were augmented with a combination of expert opinion, evidence from the literature and observational data relating to the management and cost of IVF treatment in the UK. The cost of rFSH, uFSH-HP and HMG were obtained from National Health Service list prices in the UK. The model predicted a cumulative pregnancy rate after three cycles of 57.1% for rFSH and 44.4% for both uFSH-HP and HMG. The cost of IVF treatment was 5135 pounds sterling for rFSH, 4806 pounds sterling for uFSH-HP and 4202 pounds sterling for HMG. When assessed in association with outcomes, the average cost per ongoing pregnancy was more favourable with rFSH (8992 pounds sterling) than with either uFSH-HP (10 834 pounds sterling) or HMG (9472 pounds sterling). The incremental cost per additional pregnancy was 2583 pounds sterling using rFSH instead of uFSH-HP and 7321 pounds sterling using rFSH instead of HMG. These results were robust to changes in the baseline assumptions of the model. rFSH is a cost-effective treatment strategy in ovulation induction prior to IVF.

Effectiveness of cognitive behaviour therapy for treatment-resistant depression with psychiatric comorbidity: comparison of individual versus group CBT in an interdisciplinary rehabilitation setting.

Science.gov (United States)

Hauksson, Pétur; Ingibergsdóttir, Sylvía; Gunnarsdóttir, Thórunn; Jónsdóttir, Inga Hrefna

2017-08-01

Cognitive behaviour therapy (CBT) has been shown to be effective, yet there is a paucity of research on the differential effectiveness of individual and group CBT for adults with treatment-resistant depression with psychiatric comorbidity. To investigate the effectiveness of individual and group CBT for inpatients, in an interdisciplinary rehabilitation setting; the extent of psychiatric comorbidity; and who benefits the most from group CBT. All patients (n = 181) received 6 weeks of rehabilitation (treatment as usual, TAU). In addition, they were randomly allocated to group CBT (n = 86) or individual CBT (n = 59) combined with TAU, or TAU only (n = 36). All CBT therapists were part of an interdisciplinary team, had at least 1-year CBT training, and attended weekly supervision. The same CBT manual was used for individual and group therapy, providing 12 sessions, two per week. Groups had 12-15 participants and two therapists in each session. Individual CBT was superior in efficacy to group CBT and TAU, with a large within-subject effect size (ES = 2.10). Group CBT was not superior to TAU. The benefits of treatment decreased over time, but remained large at 18-month follow-up for individual CBT (ES = 1.02), and medium for group CBT (ES = 0.46) and TAU (ES = 0.60). Individual CBT was an effective addition to TAU and showed significant improvements in symptom severity post-treatment and at 18-month follow-up. Disorder severity and comorbidity may have decreased effectiveness of group therapy primarily aimed at depression.

Effects of unplanned treatment interruptions on HIV treatment failure– results from TAHOD

Science.gov (United States)

Jiamsakul, Awachana; Kerr, Stephen J.; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L. H.; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

2016-01-01

Objectives Treatment interruptions (TI) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Methods Patients initiating cART between 2006-2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Co-variables with p30 days were associated with failure (31-180 days HR=2.66, 95%CI (1.70-4.16); 181-365 days HR=6.22, 95%CI (3.26-11.86); and >365 days HR=9.10, 95% CI (4.27-19.38), all pfailure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. PMID:26950901

Strategies for maximizing clinical effectiveness in the treatment of schizophrenia.

Science.gov (United States)

Tandon, Rajiv; Targum, Steven D; Nasrallah, Henry A; Ross, Ruth

2006-11-01

The ultimate clinical objective in the treatment of schizophrenia is to enable affected individuals to lead maximally productive and personally meaningful lives. As with other chronic diseases that lack a definitive cure, the individual's service/recovery plan must include treatment interventions directed towards decreasing manifestations of the illness, rehabilitative services directed towards enhancing adaptive skills, and social support mobilization aimed at optimizing function and quality of life. In this review, we provide a conceptual framework for considering approaches for maximizing the effectiveness of the array of treatments and other services towards promoting recovery of persons with schizophrenia. We discuss pharmacological, psychological, and social strategies that decrease the burden of the disease of schizophrenia on affected individuals and their families while adding the least possible burden of treatment. In view of the multitude of treatments necessary to optimize outcomes for individuals with schizophrenia, effective coordination of these services is essential. In addition to providing best possible clinical assessment and pharmacological treatment, the psychiatrist must function as an effective leader of the treatment team. To do so, however, the psychiatrist must be knowledgeable about the range of available services, must have skills in clinical-administrative leadership, and must accept the responsibility of coordinating the planning and delivery of this multidimensional array of treatments and services. Finally, the effectiveness of providing optimal individualized treatment/rehabilitation is best gauged by measuring progress on multiple effectiveness domains. Approaches for efficient and reliable assessment are discussed.

Concentrations of prioritized pharmaceuticals in effluents from 50 large wastewater treatment plants in the US and implications for risk estimation

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We measured the concentrations of 56 active pharmaceutical ingredients (APIs) and seven metabolites, including 50 prioritized APIs, in 24-hour composite effluent samples collected from 50 very large municipal wastewater treatment plants across the US. Hydrochlorothiazide was foun...

Treatment of melasma with low fluence, large spot size, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of melasma in Fitzpatrick skin types II-IV.

Science.gov (United States)

Brown, Alia S; Hussain, Mussarat; Goldberg, David J

2011-12-01

Melasma is a common condition affecting over six million American women. Treatment of dermal or combined melasma is difficult and does not respond well to conventional topical therapies. Various light sources have been used recently in the treatment of melasma including fractionated ablative and non-ablative lasers as well as intense pulse light. We report the use of low fluence, large spot size Q-switched, Nd:Yag laser for the treatment of melasma in skin types II-IV.

Late effects of treatment of cancer in infancy

International Nuclear Information System (INIS)

Pastore, G.; Antonelli, R.; Fine, W.; Li, F.P.; Sallan, S.E.

1982-01-01

Eighty-six children were diagnosed with cancer in infancy, followed for at lest 5 years, and assessed for late effects of disease and therapy. One child subsequently died from respiratory failure and 3 died from second primary cancers. Another patient survived second primary cancers of the skin. The high frequency of new cancers (4 observed, 0.09 expected) was attributable to host susceptibility factors and treatment effects. Kyphoscoliosis was diagnosed in 44 patients, 40 of whom had received radiotherapy to the spine. Other patients had neurologic deficits, pulmonary fibrosis, hypoplastic breasts, bowel adhesions, thyroid nodules, musculoskeletal defects, and liver fibrosis associated with tumor therapy. Sequelae of cancer were more common after treatment in infancy than in later childhood. Improved treatments and knowledge of natural history can reduce adverse effects of therapy

[IMPROVEMENT AND CHOICE OF COLOSTOMY METHOD IN THE TREATMENT OF PATIENTS, SUFFERING AN ACUTE OBTURATIVE IMPASSABILITY OF LARGE BOWEL].

Science.gov (United States)

Kustryo, V I; Langazo, O V

2015-11-01

Colostomy was done in 49 patients, suffering an acute obturative impassability of large bowel (AOILB). In 28 patients (1st group) colostomy was conducted in accordance to standard method; in 21 (2nd group)--in accordance to the method, proposed by us. Application of the method proposed for surgical treatment of AOILB have guaranteed a reduction of postoperative paracolostomal complications rate in 6.8 times, of postoperative lethality--in 2.2 times, duration of the patient stationary treatment--in 1.4 times, the rate of dressings and the dressing material expanses--in 10 times.

Effects of heat treatment on the microstructure and mechanical properties of AA2618 DC cast alloy

International Nuclear Information System (INIS)

Elgallad, E.M.; Shen, P.; Zhang, Z.; Chen, X.-G.

2014-01-01

Highlights: • The microstructure and mechanical properties of AA2618 DC cast alloy were studied. • The Al 2 CuMg, Al 2 Cu, Al 7 Cu 4 Ni, Al 7 Cu 2 (Fe,Ni) and Al 9 FeNi phases were identified. • Solution treatment at 530 °C for 5 h is the optimum solution treatment. • Different combinations of strength and ductility can be achieved. • The strengthening of AA2618 DC cast alloy was caused by GPB zones and S′ phase. - Abstract: Direct chill (DC) cast ingot plates of AA2618 alloy have been increasingly used for large-mold applications in the plastics and automotive industries. The effects of different heat treatments on the microstructure and mechanical properties of AA2618 DC cast alloy were investigated using scanning electron microscopy (SEM), transmission electron microscopy (TEM) and hardness and tensile testing. The as-cast microstructure contained a considerable amount of coarse intermetallic phases, including Al 2 CuMg, Al 2 Cu, Al 7 Cu 4 Ni, Al 7 Cu 2 (Fe,Ni) and Al 9 FeNi, resulting in poor mechanical properties. Solution treatment at 530 °C for 5 h dissolved the first three phases into the solid solution and consequently improved the mechanical properties of the alloy. By utilizing the appropriate aging temperature and time, different combinations of strength and ductility could be obtained to fulfill the design requirements of large-mold applications. The strengthening of AA2618 DC cast alloy under the aging conditions studied was caused by GPB zones and S′ precipitates. The evolution of both precipitates in terms of their size and density was observed to have a significant effect on the mechanical properties of the alloy

Effects of exendin-4 on glucose tolerance, insulin secretion, and beta-cell proliferation depend on treatment dose, treatment duration and meal contents

International Nuclear Information System (INIS)

Arakawa, Masayuki; Ebato, Chie; Mita, Tomoya; Hirose, Takahisa; Kawamori, Ryuzo; Fujitani, Yoshio; Watada, Hirotaka

2009-01-01

Beta-cell proliferation is regulated by various metabolic demands including peripheral insulin resistance, obesity, and hyperglycemia. In addition to enhancement of glucose-induced insulin secretion, agonists for glucagon-like peptide-1 receptor (GLP-1R) stimulate proliferation and inhibit apoptosis of beta-cells, thereby probably preserve beta-cell mass. To evaluate the beta-cell preserving actions of GLP-1R agonists, we assessed the acute and chronic effects of exendin-4 on beta-cell proliferation, mass and glucose tolerance in C57BL/6J mice under various conditions. Short-term administration of high-dose exendin-4 transiently stimulated beta-cell proliferation. Comparative transcriptomic analysis showed upregulation of IGF-1 receptor and its downstream effectors in islets. Treatment of mice with exendin-4 daily for 4 weeks (long-term administration) and feeding high-fat diet resulted in significant inhibition of weight gain and improvement of glucose tolerance with reduced insulin secretion and beta-cell mass. These findings suggest that long-term GLP-1 treatment results in insulin sensitization of peripheral organs, rather than enhancement of beta-cell proliferation and function, particularly when animals are fed high-fat diet. Thus, the effects of exendin-4 on glucose tolerance, insulin secretion, and beta-cell proliferation largely depend on treatment dose, duration of treatment and meal contents. While GLP-1 enhances proliferation of beta-cells in some diabetic mice models, our results suggest that GLP-1 stimulates beta-cell growth only when expansion of beta-cell mass is required to meet metabolic demands.

Effects of exendin-4 on glucose tolerance, insulin secretion, and beta-cell proliferation depend on treatment dose, treatment duration and meal contents

Energy Technology Data Exchange (ETDEWEB)

Arakawa, Masayuki; Ebato, Chie; Mita, Tomoya [Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo (Japan); Hirose, Takahisa [Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo (Japan); Center for Therapeutic Innovations in Diabetes, Juntendo University School of Medicine, Tokyo (Japan); Kawamori, Ryuzo [Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo (Japan); Center for Therapeutic Innovations in Diabetes, Juntendo University School of Medicine, Tokyo (Japan); Center for Beta Cell Biology and Regeneration, Juntendo University School of Medicine, Tokyo (Japan); Sportology Center, Juntendo University School of Medicine, Tokyo (Japan); Fujitani, Yoshio, E-mail: fujitani@juntendo.ac.jp [Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo (Japan); Center for Therapeutic Innovations in Diabetes, Juntendo University School of Medicine, Tokyo (Japan); Watada, Hirotaka, E-mail: hwatada@juntendo.ac.jp [Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo (Japan); Sportology Center, Juntendo University School of Medicine, Tokyo (Japan)

2009-12-18

Beta-cell proliferation is regulated by various metabolic demands including peripheral insulin resistance, obesity, and hyperglycemia. In addition to enhancement of glucose-induced insulin secretion, agonists for glucagon-like peptide-1 receptor (GLP-1R) stimulate proliferation and inhibit apoptosis of beta-cells, thereby probably preserve beta-cell mass. To evaluate the beta-cell preserving actions of GLP-1R agonists, we assessed the acute and chronic effects of exendin-4 on beta-cell proliferation, mass and glucose tolerance in C57BL/6J mice under various conditions. Short-term administration of high-dose exendin-4 transiently stimulated beta-cell proliferation. Comparative transcriptomic analysis showed upregulation of IGF-1 receptor and its downstream effectors in islets. Treatment of mice with exendin-4 daily for 4 weeks (long-term administration) and feeding high-fat diet resulted in significant inhibition of weight gain and improvement of glucose tolerance with reduced insulin secretion and beta-cell mass. These findings suggest that long-term GLP-1 treatment results in insulin sensitization of peripheral organs, rather than enhancement of beta-cell proliferation and function, particularly when animals are fed high-fat diet. Thus, the effects of exendin-4 on glucose tolerance, insulin secretion, and beta-cell proliferation largely depend on treatment dose, duration of treatment and meal contents. While GLP-1 enhances proliferation of beta-cells in some diabetic mice models, our results suggest that GLP-1 stimulates beta-cell growth only when expansion of beta-cell mass is required to meet metabolic demands.

Combined Treatment of Large Hepatocellular Carcinoma with Transcatheter Arterial Chemoembolization and Percutaneous Ethanol Injection with a Multipronged Needle: Experimental and Clinical Investigation

International Nuclear Information System (INIS)

Kawamura, Rinako; Seki, Toshihito; Umehara, Hideto; Ikeda, Kozo; Inokuchi, Ryosuke; Asayama, Toshiki; Yamaguchi, Takashi; Takahashi, Yu; Sakao, Masayuki; Lencioni, Riccardo; Okazaki, Kazuichi

2012-01-01

Purpose: This study was designed to evaluate the usefulness of percutaneous ethanol injection (PEI) with a multipronged needle for the treatment of large hepatocellular carcinoma (HCC). An experimental animal study and a clinical investigation were performed. Methods: In the experimental study, 20 ml of 99.5% ethanol was injected into porcine liver in vivo with a multipronged needle (n = 5) or a straight needle (n = 5), and the volumes of coagulation necrosis were compared. In the clinical investigation, PEI was performed in 17 patients (10 men, 7 women; mean age 73.4 ± 6.7 years) with single, large HCC (mean tumor diameter, 47.2 ± 11.5 mm; range, 32–70 mm) by using a multipronged needle. Fifteen of 17 patients received transarterial chemoembolization (TACE) before PEI. Results: The volume of coagulation in porcine liver in vivo was significantly increased with the multipronged needle compared with the straight needle (longest perpendicular diameters, 34.2 ± 3.6 mm × 30.2 ± 3.6 mm vs. 22.6 ± 2.5 mm × 19 ± 2.2 mm, respectively; P < 0.05). In the clinical trial, initial complete response (CR) of the tumor was achieved in 17 of 17 patients, 7 of whom required two PEI sessions. During the follow-up, local recurrence was detected in 4 of 17 patients at 3–19 months after the procedure, for a rate of sustained local CR of 76%. No major complication occurred. Conclusions: Use of a multipronged needle substantially increases the volume of coagulation in vivo with respect to the conventional PEI technique. Combined TACE and PEI with multipronged needles is a safe and effective option for percutaneous treatment of single, large HCC.

Effect of pulsed electric fields treatment and mash size on extraction and composition of apple juices.

Science.gov (United States)

Turk, Mohammad F; Baron, Alain; Vorobiev, Eugene

2010-09-08

This study explored the effect of pulsed electric field (PEF) treatment (E=450 V/cm; tt=10 ms; Eapple mash size on juice yield, polyphenolic compounds, sugars, and malic acid. Juice yield increased significantly after PEF treatment of large mash (Y=71.4%) and remained higher than the juice yield obtained for a control small mash (45.6%). The acid sweet balance was not altered by PEF. A correlation was established between the decrease of light absorbance (control: 1.43; treated: 1.10) and the decline of native polyphenols yield due to PEF treatment (control: 9.6%; treated: 5.9% for small mash). An enhanced oxidation of phenolic compounds in cells due to electroporation of the inner cell membrane and the adsorption of the oxidized products on the mash may explain both the lower light absorbance and the lower native polyphenol concentration.

Imprint of non-linear effects on HI intensity mapping on large scales

Energy Technology Data Exchange (ETDEWEB)

Umeh, Obinna, E-mail: umeobinna@gmail.com [Department of Physics and Astronomy, University of the Western Cape, Cape Town 7535 (South Africa)

2017-06-01

Intensity mapping of the HI brightness temperature provides a unique way of tracing large-scale structures of the Universe up to the largest possible scales. This is achieved by using a low angular resolution radio telescopes to detect emission line from cosmic neutral Hydrogen in the post-reionization Universe. We use general relativistic perturbation theory techniques to derive for the first time the full expression for the HI brightness temperature up to third order in perturbation theory without making any plane-parallel approximation. We use this result and the renormalization prescription for biased tracers to study the impact of nonlinear effects on the power spectrum of HI brightness temperature both in real and redshift space. We show how mode coupling at nonlinear order due to nonlinear bias parameters and redshift space distortion terms modulate the power spectrum on large scales. The large scale modulation may be understood to be due to the effective bias parameter and effective shot noise.

A review on bisphenol A occurrences, health effects and treatment process via membrane technology for drinking water.

Science.gov (United States)

Muhamad, Mimi Suliza; Salim, Mohd Razman; Lau, Woei Jye; Yusop, Zulkifli

2016-06-01

Massive utilization of bisphenol A (BPA) in the industrial production of polycarbonate plastics has led to the occurrence of this compound (at μg/L to ng/L level) in the water treatment plant. Nowadays, the presence of BPA in drinking water sources is a major concern among society because BPA is one of the endocrine disruption compounds (EDCs) that can cause hazard to human health even at extremely low concentration level. Parallel to these issues, membrane technology has emerged as the most feasible treatment process to eliminate this recalcitrant contaminant via physical separation mechanism. This paper reviews the occurrences and effects of BPA toward living organisms as well as the application of membrane technology for their removal in water treatment plant. The potential applications of using polymeric membranes for BPA removal are also discussed. Literature revealed that modifying membrane surface using blending approach is the simple yet effective method to improve membrane properties with respect to BPA removal without compromising water permeability. The regeneration process helps in maintaining the performances of membrane at desired level. The application of large-scale membrane process in treatment plant shows the feasibility of the technology for removing BPA and possible future prospect in water treatment process.

Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.

Science.gov (United States)

Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V

2010-01-01

Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for

The Effect of Combined Aspirin and Clopidogrel Treatment on Cancer Incidence.

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Leader, Avi; Zelikson-Saporta, Ravit; Pereg, David; Spectre, Galia; Rozovski, Uri; Raanani, Pia; Hermoni, Doron; Lishner, Michael

2017-07-01

Multiple studies have shown an association between aspirin treatment and a reduction in newly diagnosed cancer. Conversely, there are conflicting clinical and laboratory data on the effect of combined clopidogrel and aspirin therapy on cancer incidence, including analyses suggesting an increased cancer risk. No large-scale cohort study has been performed to address this issue in a heterogeneous real-world scenario. We investigated the effect of clopidogrel and aspirin on cancer incidence compared with aspirin alone and no antiplatelet therapy. A population-based historical cohort study of subjects aged ≥50 years covered by Clalit Health Services, an Israeli health maintenance organization, was performed. Patients treated with the newer antiplatelet drugs, prasugrel or ticagrelor, which, like clopidogrel, inhibit adenosine diphosphate receptors, and those with prior cancer were excluded. Prescription records of antiplatelet medication were retrieved. The cohort included 183,912 subjects diagnosed with 21,974 cancer cases based upon the International Classification of Diseases, Ninth Revision. Dual aspirin and clopidogrel was prescribed in 9.6%, while 49% received aspirin alone and 41% used neither. Compared with nonusers, there was a lower risk of cancer in subjects exposed to aspirin with (hazard ratio [HR] 0.46; 95% confidence interval [CI], 0.44-0.49) or without clopidogrel (HR 0.54; 95% CI, 0.52-0.56), on long-term follow-up. Combined treatment was associated with a lower cancer risk than the aspirin-only group (HR 0.92; 95% CI, 0.86-0.97). Dual clopidogrel and aspirin treatment is safe regarding the cancer risk. This study generates the hypothesis that clopidogrel may reduce cancer incidence. Copyright © 2017 Elsevier Inc. All rights reserved.

Underground structure pattern and multi AO reaction with step feed concept for upgrading an large wastewater treatment plant

Science.gov (United States)

Peng, Yi; Zhang, Jie; Li, Dong

2018-03-01

A large wastewater treatment plant (WWTP) could not meet the new demand of urban environment and the need of reclaimed water in China, using a US treatment technology. Thus a multi AO reaction process (Anaerobic/oxic/anoxic/oxic/anoxic/oxic) WWTP with underground structure was proposed to carry out the upgrade project. Four main new technologies were applied: (1) multi AO reaction with step feed technology; (2) deodorization; (3) new energy-saving technology such as water resource heat pump and optical fiber lighting system; (4) dependable old WWTP’s water quality support measurement during new WWTP’s construction. After construction, upgrading WWTP had saved two thirds land occupation, increased 80% treatment capacity and improved effluent standard by more than two times. Moreover, it had become a benchmark of an ecological negative capital changing to a positive capital.

Apathy in Alzheimer’s Disease: Any Effective Treatment?

Directory of Open Access Journals (Sweden)

Raffaele Rea

2014-01-01

Full Text Available Objective. This review has evaluated the effectiveness of pharmacological treatment of apathy in patients with Alzheimer’s disease (AD. Methods. A systematic literature search was conducted on published clinical trials assessing the effects of pharmacological treatment on apathy in AD over the last 10 years. Results. Fourteen studies considered of good quality were included in the analysis (4 randomized controlled trials, 9 open-label studies, and 1 retrospective analysis. Cholinesterase inhibitors were investigated in 9 studies, monoaminergic compounds such as methylphenidate and modafinil in two trials and one trial, respectively, and Ginkgo biloba (EGb 761 extract and citalopram in one study each. Cholinesterase inhibitors did not show statistical significant effect in 1 RCT study but were associated to improvement in 3 open-label studies. Methylphenidate elicited a small but significant activity accompanied by relevant side effects such as high blood pressure, cough, and osteoarticular pain. EGb 761 was well tolerated and countered apathy. Other treatments induced modest improvements or were ineffective. Conclusions. Apathy treatment remains a challenge and there is no evident advantage of any specific pharmacotherapy tested so far. The development of controlled studies according to updated guidelines for the diagnosis of apathy in patients with AD is desirable.

Cost-saving treatment strategies in in vitro fertilization: a combined economic evaluation of two large randomized clinical trials comparing highly purified human menopausal gonadotropin and recombinant follicle-stimulating hormone alpha.

Science.gov (United States)

Wechowski, Jaroslaw; Connolly, Mark; Schneider, Dirk; McEwan, Philip; Kennedy, Richard

2009-04-01

To assess the cost-effectiveness of two gonadotropin treatments that are available in the United Kingdom in light of limited public funding and the fundamental role of costs in IVF treatment decisions. An economic evaluation based on two large randomized clinical trials in IVF patients using a simulation model. Fifty-three fertility clinics in 13 European countries and Israel. Women indicated for treatment with IVF (N = 986), aged 18-38, participating in double-blind, randomized controlled trials. Highly purified menotropin (HP-hMG, Menopur) or recombinant follitropin alpha (rFSH, Gonal-F). Cost per IVF cycle and cost per live birth for HP-hMG and rFSH alpha. HP-hMG was more effective and less costly versus rFSH for both IVF cost per live birth and for IVF cost per baby (incremental cost-effectiveness ratio was negative). The mean costs per IVF treatment for HP-hMG and rFSH were 2408 pounds (95% confidence interval [CI], 2392 pounds, 2421 pounds) and 2660 pounds (95% CI 2644 pounds, 2678 pounds), respectively. The mean cost saving of 253 pounds per cycle using HP-hMG allows one additional cycle to be delivered for every 9.5 cycles. Treatment with HP-hMG was dominant compared with rFSH in the United Kingdom. Gonadotropin costs should be considered alongside live-birth rates to optimize outcomes using scarce health-care resources.

Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder.

Science.gov (United States)

van Apeldoorn, F J; Stant, A D; van Hout, W J P J; Mersch, P P A; den Boer, J A

2014-04-01

The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT+SSRI). Cost-effectiveness was examined based on the data from a multicenter randomized controlled trial. The Hamilton Anxiety Rating Scale was selected as a primary health outcome measure. Data on costs from a societal perspective (i.e., direct medical, direct non-medical, and indirect non-medical costs) were collected in the study sample (N=150) throughout a 24-month period in which patients received active treatment during the first twelve months and were seen twice for follow-up in the next twelve months. Total costs were largely influenced by costs of the interventions and productivity losses. The mean total societal costs were lower for CBT as compared to SSRI and CBT+SSRI. Costs of medication use were substantial for both SSRI and CBT+SSRI. When examining the balance between costs and health outcomes, both CBT and CBT+SSRI led to more positive outcomes than SSRI. Cognitive behavioral therapy is associated with the lowest societal costs. Cognitive behavioral therapy and CBT+SSRI are more cost-effective treatments for panic disorder with or without agoraphobia as compared to SSRI only. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hypersingular integral equations, waveguiding effects in Cantorian Universe and genesis of large scale structures

International Nuclear Information System (INIS)

Iovane, G.; Giordano, P.

2005-01-01

In this work we introduce the hypersingular integral equations and analyze a realistic model of gravitational waveguides on a cantorian space-time. A waveguiding effect is considered with respect to the large scale structure of the Universe, where the structure formation appears as if it were a classically self-similar random process at all astrophysical scales. The result is that it seems we live in an El Naschie's o (∞) Cantorian space-time, where gravitational lensing and waveguiding effects can explain the appearing Universe. In particular, we consider filamentary and planar large scale structures as possible refraction channels for electromagnetic radiation coming from cosmological structures. From this vision the Universe appears like a large self-similar adaptive mirrors set, thanks to three numerical simulations. Consequently, an infinite Universe is just an optical illusion that is produced by mirroring effects connected with the large scale structure of a finite and not a large Universe

Cost-effectiveness of emergency department-initiated treatment for opioid dependence.

Science.gov (United States)

Busch, Susan H; Fiellin, David A; Chawarski, Marek C; Owens, Patricia H; Pantalon, Michael V; Hawk, Kathryn; Bernstein, Steven L; O'Connor, Patrick G; D'Onofrio, Gail

2017-11-01

In a recent randomized trial, patients with opioid dependence receiving brief intervention, emergency department (ED)-initiated buprenorphine and ongoing follow-up in primary care with buprenorphine (buprenorphine) were twice as likely to be engaged in addiction treatment compared with referral to community-based treatment (referral) or brief intervention and referral (brief intervention). Our aim was to evaluate the relative cost-effectiveness of these three methods of intervening on opioid dependence in the ED. Measured health-care use was converted to dollar values. We considered a health-care system perspective and constructed cost-effectiveness acceptability curves that indicate the probability each treatment is cost-effective under different thresholds of willingness-to-pay for outcomes studied. An urban ED in the United States. Opioid-dependent patients aged 18 years or older. Self-reported 30-day assessment data were used to construct cost-effectiveness acceptability curves for patient engagement in formal addiction treatment at 30 days and the number of days illicit opioid-free in the past week. Considering only health-care system costs, cost-effectiveness acceptability curves indicate that at all positive willingness-to-pay values, ED-initiated buprenorphine treatment was more cost-effective than brief intervention or referral. For example, at a willingness-to-pay threshold of $1000 for 30-day treatment engagement, we are 79% certain ED-initiated buprenorphine is most cost-effective compared with other studied treatments. Similar results were found for days illicit opioid-free in the past week. Results were robust to secondary analyses that included patients with missing cost data, included crime and patient time costs in the numerator, and to changes in unit price estimates. In the United States, emergency department-initiated buprenorphine intervention for patients with opioid dependence provides high value compared with referral to community

Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.

Science.gov (United States)

Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

2016-09-01

To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these

Recidivism after treatment in a forensic youth-psychiatric setting: the effect of treatment characteristics

NARCIS (Netherlands)

van der Put, C.E.; Asscher, J.J.; Stams, G.J.J.M.; van der Laan, P.H.; Breuk, R.; Jongman, E.; Doreleijers, T.

2013-01-01

The aim of this study was to examine the effect of treatment characteristics on recidivism in a forensic youth-psychiatric outpatient clinic. The treatment offered comprised functional family therapy (FFT), individual cognitive behavioural therapy (CBT), or CBT in combination with parent training.

Effect of fructose diphosphate combined with large-dose vitamin C therapy on the myocardial oxidative stress injury after neonatal asphyxia

Directory of Open Access Journals (Sweden)

Chun-Hua Liang1

2017-04-01

Full Text Available Objective: To study the effect of fructose diphosphate combined with large-dose vitamin C therapy on the myocardial oxidative stress injury after neonatal asphyxia. Methods: 40 patients with neonatal asphyxia who were treated in our hospital between June 2013 and April 2016 were collected and divided into the control group (n=20 who received large-dose vitamin C therapy and the observation group (n=20 who received fructose diphosphate combined with large-dose vitamin C therapy according to the double-blind randomized control method, and the treatment lasted for 10 d. Immediately after admission and after 10 d of treatment, RIA method was used to detect the serum levels of oxidative stress indexes, color Doppler diasonograph was used to determine left cardiac function parameters, and the myocardial enzyme spectrum detector was used to determine myocardial enzyme spectrum index levels. Results: Immediately after admission, the differences in the systemic oxidative stress degree, the left cardiac function damage degree and the myocardial enzyme spectrum index levels were not statistically significant between two groups of patients (P>0.05. After 10 d of treatment, serum malondialdehyde (MDA, advanced oxidation protein products (AOPP, creatine kinase isoenzyme (CK-MB, N-terminal pro-brain natriuretic peptide (Nt-proBNP, heart-type fatty acid-binding protein (H-FABP and troponin I (cTnI contents of observation group were lower than those of control group (P<0.05 while superoxide dismutase (SOD content was higher than that of control group (P<0.05, and the left cardiac function parameter ejection time (ET level was higher than that of control group (P<0.05 while left ventricular isovolumetric contraction time (ICT and left ventricular isovolumetric relaxation time (IRT levels were lower than those of control group (P<0.05. Conclusion: Fructose diphosphate combined with large-dose vitamin C can reduce the systemic oxidative stress of neonatal asphyxia

Renormalization in Large Momentum Effective Theory of Parton Physics.

Science.gov (United States)

Ji, Xiangdong; Zhang, Jian-Hui; Zhao, Yong

2018-03-16

In the large-momentum effective field theory approach to parton physics, the matrix elements of nonlocal operators of quark and gluon fields, linked by straight Wilson lines in a spatial direction, are calculated in lattice quantum chromodynamics as a function of hadron momentum. Using the heavy-quark effective theory formalism, we show a multiplicative renormalization of these operators at all orders in perturbation theory, both in dimensional and lattice regularizations. The result provides a theoretical basis for extracting parton properties through properly renormalized observables in Monte Carlo simulations.

Musical hallucinations: review of treatment effects

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Jan eCoebergh

2015-06-01

Full Text Available AbstractBackground: Despite an increased scientific interest in musical hallucinations throughout the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare.Objective: To review the effects of published treatment methods for musical hallucinations.Methods: A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analysed the treatment results in relation to the aetiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion and other pathology, epilepsy or intoxication.Results: Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct aetiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g. more acoustic stimulation are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being more helpful than antiepileptics (which are still better than antipsychotics. The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication is the main aetiological factor, it is important to stop or switch the

Psychological approaches in the treatment of specific phobias: A meta-analysis

NARCIS (Netherlands)

Wolitzky-Taylor, K.B.; Horowitz, J.D.; Powers, M.B.; Telch, M.J.

2008-01-01

Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also

The side-effects to CPAP treatment inventory: the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.

Science.gov (United States)

Broström, Anders; Arestedt, Kristofer Franzén; Nilsen, Per; Strömberg, Anna; Ulander, Martin; Svanborg, Eva

2010-12-01

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74-0.86) and acceptable for the subscales (Cronbach's α = 0.62-0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment. © 2010 European Sleep Research Society.

20 years of experience on treatment of large contaminated components and on clearance of material for recycling

International Nuclear Information System (INIS)

Lorenzen, Joachim; Lindberg, Maria; Amcoff, Bjoern; Wirendal, Bo

2005-01-01

This paper will describe the treatment of contaminated, large, retired components from NPP:s, at low and intermediate activity waste levels for recycling in Sweden. Decontamination and melting of various large components, as well as other metal scrap, has been conducted at Studsvik since the mid 1980:ies. Experience on clearance for recycling, i.e. for unconditional re-use of the metals in the public domain will be described. The contaminated material may be Co-60 dominated as well as Uranium Bearing Waste. During these years different techniques for decontamination and segmentation as well as pre- and post treatment have been developed and successively applied at Studsvik melting facility in Nykoeping, Sweden. This collective experience is presently used for the planning and treatment of both domestic and foreign larger components, like heat exchangers, reactors vessel heads, turbine parts, steam generators, fuel bottles and Giant boilers. During 2005 one 300 ton full size, 400 m 3 Westinghouse Steam Generator is under treatment using advanced decontamination, segmentation and melting techniques to be applied in a specifically designed and confined environment. The conduction of demonstration projects as well as commercial projects will be explained and described. The Studsvik melting facility is today treating components and scrap metal comprising stainless and carbon steel as well as aluminium, copper, brass and lead. Studsvik RadWaste has licenses for treating not only components from Swedish nuclear facilities but also for processing components from nuclear industries outside Sweden, including temporary import and export within a limited time window for each international project. Direct clearance or clearance after limited decay storage at Studsvik site is possible. The high Recycling Rate is due to optimized production to leave an extremely low percentage of secondary waste, including post-treatment of the secondary waste volume. Further, the waste volume

Large scale obscuration and related climate effects open literature bibliography

Energy Technology Data Exchange (ETDEWEB)

Russell, N.A.; Geitgey, J.; Behl, Y.K.; Zak, B.D.

1994-05-01

Large scale obscuration and related climate effects of nuclear detonations first became a matter of concern in connection with the so-called ``Nuclear Winter Controversy`` in the early 1980`s. Since then, the world has changed. Nevertheless, concern remains about the atmospheric effects of nuclear detonations, but the source of concern has shifted. Now it focuses less on global, and more on regional effects and their resulting impacts on the performance of electro-optical and other defense-related systems. This bibliography reflects the modified interest.

Large scale obscuration and related climate effects open literature bibliography

International Nuclear Information System (INIS)

Russell, N.A.; Geitgey, J.; Behl, Y.K.; Zak, B.D.

1994-05-01

Large scale obscuration and related climate effects of nuclear detonations first became a matter of concern in connection with the so-called ''Nuclear Winter Controversy'' in the early 1980's. Since then, the world has changed. Nevertheless, concern remains about the atmospheric effects of nuclear detonations, but the source of concern has shifted. Now it focuses less on global, and more on regional effects and their resulting impacts on the performance of electro-optical and other defense-related systems. This bibliography reflects the modified interest

Variable-Frequency Ultrasonic Treatment on Microstructure and Mechanical Properties of ZK60 Alloy during Large Diameter Semi-Continuous Casting

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Xingrui Chen

2017-05-01

Full Text Available Traditional fixed-frequency ultrasonic technology and a variable-frequency ultrasonic technology were applied to refine the as-cast microstructure and improve the mechanical properties of a ZK60 (Mg–Zn–Zr alloy during large diameter semi-continuous casting. The acoustic field propagation was obtained by numerical simulation. The microstructure of the as-cast samples was characterized by optical and scanning electron microscopy. The variable-frequency ultrasonic technology shows its outstanding ability in grain refinement compared with traditional fixed-ultrasonic technology. The variable-frequency acoustic field promoted the formation of small α-Mg globular grains and changed the distribution and morphology of β-phases throughout the castings. Ultimate tensile strength and elongation are increased to 280 MPa and 8.9%, respectively, which are 19.1% and 45.9% higher than the values obtained from billets without ultrasonic treatment and are 11.6% and 18.7% higher than fixed-frequency ultrasound treated billets. Different refinement efficiencies appear in different districts of billets attributed to the sound attenuation in melt. The variable-frequency acoustic field improves the refinement effect by enhancing cavitation-enhanced heterogeneous nucleation and dendrite fragmentation effects.

Treatment Effectiveness of Amantadine Against Dengue Virus Infection.

Science.gov (United States)

Lin, Chieh-Cheng; Chen, Wen-Ching

2016-12-05

BACKGROUND About 400 million cases of dengue, a mosquito-borne disease, are reported annually, but no drug is yet available for treatment. In 1988, at Feng Lin Clinic, Taiwan, we encountered about 10,000 cases and tested various drugs before confirming an antiviral effect of amantadine against dengue virus in vitro. After we administered amantadine to patients for 1-2 days, most achieved full remission. None experienced potentially life-threatening dengue hemorrhagic fever or dengue shock syndrome. Herein, we present 34 cases from recent clinical experience that show amantadine's unusual effect against dengue virus infection. CASE REPORT We divided 34 patients with symptoms of dengue fever, confirmed by a screening test, into 3 groups: 6 Category 1 patients received amantadine at onset, 21 Category 2 patients received amantadine within 2-6 days, and 7 Contrast group patients received no amantadine because they visited other clinics or were admitted to a large hospital. When Category 1 patients were treated with amantadine 100 mg 3 times per day, all symptoms dramatically subsided within 1-2 days. In Category 2 patients, most symptoms diminished within 1-2 days after starting the same regimen. In the Contrast group, all symptoms persisted 7 days after onset. White blood cell and platelet counts in Category 1 and 2 patients recovered to normal range, but remained below low normal in the Contrast group. CONCLUSIONS Amantadine is effective and should be given as soon as possible to stop the disease course if dengue fever is confirmed through screening or clinical signs and symptoms. A well-designed larger sample study is warranted to test this effectiveness.

Modelling the effects of treatment and quarantine on measles

Science.gov (United States)

Beay, Lazarus Kalvein

2018-03-01

Treatment and quarantine are efforts to cure as well as to overcome the spread of diseases including measles. The spread of measles can be expressed by mathematical modelling in the form of nonlinear dynamical systems. In this study was conducted on the spread of measles by considering the effect of treatment and quarantine on the infected individuals. By using the basic reproduction number of the model, can be analyzed the effects of treatment and quarantine to reduce the spread of measles. Basic reproduction number of models is monotonically descreasing as treatment and quarantine increasing. Numerical simulations conducted on the analysis of the results. The results showed that treatment and quarantine was given to infected individuals who were infectious has a major influence to eliminate measles from the system.

Simulation model for planning metallurgical treatment of large-size billets

International Nuclear Information System (INIS)

Timofeev, M.A.; Echeistova, L.A.; Kuznetsov, V.G.; Semakin, S.V.; Krivonogov, A.B.

1989-01-01

The computerized simulation system ''Ritm'' for planning metallurgical treatment of billets is developed. Three principles, specifying the organization structure of the treatment cycle are formulated as follows: a cycling principle, a priority principle and a principle of group treatment. The ''Ritm'' software consists of three independent operating systems: preparation of source data, simulation, data output

Mode-Specific Effects among Three Treatments for Depression.

Science.gov (United States)

Imber, Stanley D.; And Others

1990-01-01

Randomly assigned 250 depressed outpatients to interpersonal psychotherapy, cognitive-behavioral therapy, imipramine plus clinical management, or pill placebo plus clinical management treatments. All treatments demonstrated significant symptom reduction with few differences in general outcomes. None of the therapies produced consistent effects on…

Effect of physical treatment on Trichoderma reesei cells

International Nuclear Information System (INIS)

Kumakura, M.; Kaetsu, I.

1984-01-01

The effect of physical treatment such as freezing and gamma-ray irradiation on Trichoderma reesei cells was studied. The decrease phenomena of cellulase production, which was observed in the culture of the cells using wheat bran extract, was improved by physical treatment. (author)

Effective treatment strategies against Ebola virus

Directory of Open Access Journals (Sweden)

Amina Yaqoob

2015-08-01

Full Text Available Ebola virus (EBOV, a member of order Mononegavirales is most famous for causing the endemics of hemorrhagic fever in different countries of the world. Various effective treatment for EBOV are available presently but different clinical trials and experimental studies on animal models are ongoing for this purpose. Results from different studies showed that selective vaccines and therapeutic drugs have potential to interfere the viral life events within host cell in order to inhibit its replication. Various pre-clinical trials in this regard are proved successful on non-human primates (NHPs and found to be significant in inhibiting EBOV infections. It is the need of hour to develop effective vaccines against Ebola virus to combat this problem as soon as possible. The present article is a brief review on potential treatment strategies against Ebola virus.

Estimation of wildfire size and risk changes due to fuels treatments

Science.gov (United States)

Cochrane, M.A.; Moran, C.J.; Wimberly, M.C.; Baer, A.D.; Finney, M.A.; Beckendorf, K.L.; Eidenshink, J.; Zhu, Z.

2012-01-01

Human land use practices, altered climates, and shifting forest and fire management policies have increased the frequency of large wildfires several-fold. Mitigation of potential fire behaviour and fire severity have increasingly been attempted through pre-fire alteration of wildland fuels using mechanical treatments and prescribed fires. Despite annual treatment of more than a million hectares of land, quantitative assessments of the effectiveness of existing fuel treatments at reducing the size of actual wildfires or how they might alter the risk of burning across landscapes are currently lacking. Here, we present a method for estimating spatial probabilities of burning as a function of extant fuels treatments for any wildland fire-affected landscape. We examined the landscape effects of more than 72 000 ha of wildland fuel treatments involved in 14 large wildfires that burned 314 000 ha of forests in nine US states between 2002 and 2010. Fuels treatments altered the probability of fire occurrence both positively and negatively across landscapes, effectively redistributing fire risk by changing surface fire spread rates and reducing the likelihood of crowning behaviour. Trade offs are created between formation of large areas with low probabilities of increased burning and smaller, well-defined regions with reduced fire risk.

Different goods, different effects: Exploring the effects of generalized social trust in large-N collective action

DEFF Research Database (Denmark)

Sønderskov, Kim Mannemar

2009-01-01

Does generalized social trust help solve large-N collective action problems? This paper argues so, offering a novel explanation for the relationship: People tend to cooperate if they expect others to be cooperating, which implies that people holding generalized social trust more readily cooperate...... in large-N dilemmas because they expect that most people will cooperate. The paper tests the explanation in a rigorous design. The analyses show a positive, robust effect of generalized social trust on public good provision, but no effect is found in a joint product situation. This supports the hypothesis......, indicating that trust specifically enhances cooperation in collective action dilemmas....

Effect of Bauhinia holophylla treatment in Streptozotocin-induced diabetic rats.

Science.gov (United States)

Pinheiro, Marcelo S; Rodrigues, Luhara S; S, Leila; Moraes-Souza, Rafaianne Q; Soares, Thaigra S; Américo, Madileine F; Campos, Kleber E; Damasceno, Débora C; Volpato, Gustavo T

2017-01-01

Bauhinia holophylla, commonly known as "cow's hoof", is widely used in Brazilian folk medicine for the diabetes treatment. Therefore, the aim of this study was at evaluating the aqueous extract effect of Bauhinia holophylla leaves treatment on the streptozotocin-induced diabetic rats. Diabetes was induced by Streptozotocin (40 mg/Kg) in female Wistar rats. Oral administration of aqueous extract of Bauhinia holophylla leaves was given to non-diabetic and diabetic rats at a dose of 400 mg/kg during 21 days. On day 17 of treatment, the Oral Glucose Tolerance Test was performed to determine the area under the curve. At the end of the treatment, the animals were anesthetized and blood was collected for serum biochemical parameters analysis. After treatment with Bauhinia holophylla extract, non-diabetic and diabetic rats presented no glycemic changes. On the other hand, the plant treatment decreased body weight and increased ALT and AST activities. In conclusion, the treatment with aqueous extract of B. holophylla leaves given to diabetic rats presented no hypoglycemic effect in nondiabetic animals and no antidiabetic effect in diabetic animals with the doses studied. In addition, the diabetic animals treated with the B. holophylla extract showed inconvenient effects and its indiscriminate consumption requires particular carefulness.

Effective field theories in the large-N limit

International Nuclear Information System (INIS)

Weinberg, S.

1997-01-01

Various effective field theories in four dimensions are shown to have exact nontrivial solutions in the limit as the number N of fields of some type becomes large. These include extended versions of the U (N) Gross-Neveu model, the nonlinear O(N) σ model, and the CP N-1 model. Although these models are not renormalizable in the usual sense, the infinite number of coupling types allows a complete cancellation of infinities. These models provide qualitative predictions of the form of scattering amplitudes for arbitrary momenta, but because of the infinite number of free parameters, it is possible to derive quantitative predictions only in the limit of small momenta. For small momenta the large-N limit provides only a modest simplification, removing at most a finite number of diagrams to each order in momenta, except near phase transitions, where it reduces the infinite number of diagrams that contribute for low momenta to a finite number. copyright 1997 The American Physical Society

Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: A large scale, multi-centered, longitudinal study in China.

Science.gov (United States)

Zeng, Qingzhi; Wang, Wei Chun; Fang, Yiru; Mellor, David; Mccabe, Marita; Byrne, Linda; Zuo, Sai; Xu, Yifeng

2016-07-30

Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients' needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients' self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Treatment of giant and large fusiform middle cerebral artery aneurysms with excision and interposition radial artery graft in a 4-year-old child: case report.

Science.gov (United States)

Mrak, Goran; Paladino, Josip; Stambolija, Vasilije; Nemir, Jakob; Sekhar, Laligam N

2014-03-01

We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and radial artery interposition graft. A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right middle cerebral artery (MCA). Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, 1 giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year. Large fusiform MCA aneurysms may be difficult to treat, but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was a very successful treatment in this child.

Sleep Disturbance During Smoking Cessation: Withdrawal or Side Effect of Treatment?

Science.gov (United States)

Ashare, Rebecca L; Lerman, Caryn; Tyndale, Rachel F; Hawk, Larry W; George, Tony P; Cinciripini, Paul; Schnoll, Robert A

2017-06-01

The nicotine-metabolite ratio (NMR) predicts treatment response and is related to treatment side effect severity. Sleep disturbance may be one important side effect, but understanding sleep disturbance effects on smoking cessation is complicated by the fact that nicotine withdrawal also produces sleep disturbance. To evaluate the effects of withdrawal and treatment side effects on sleep disturbance. This is a secondary analysis of data from a clinical trial (Lerman et al., 2015) of 1,136 smokers randomised to placebo ( n = 363), transdermal nicotine (TN; n = 381), or varenicline ( n = 392) and stratified based on NMR (559 slow metabolisers; 577 normal metabolisers). Sleep disturbance was assessed at baseline and at 1-week following the target quit date (TQD). We also examined whether sleep disturbance predicted 7-day point-prevalence abstinence at end-of-treatment (EOT). The varenicline and TN groups exhibited greater increases in sleep disturbance (vs. placebo; treatment × time interaction; p = 0.005), particularly among those who quit smoking at 1-week post-TQD. There was a main effect of NMR ( p = 0.04), but no interactions with treatment. TN and varenicline attenuated withdrawal symptoms unrelated to sleep (vs. placebo). Greater baseline sleep disturbance predicted relapse at EOT ( p = 0.004). Existing treatments may not mitigate withdrawal-related sleep disturbance and adjunctive treatments that target sleep disturbance may improve abstinence rates.

Evaluating eating behavior treatments by FDA standards

Directory of Open Access Journals (Sweden)

A. Janet eTomiyama

2014-01-01

Full Text Available Behavioral treatments for obesity are not evaluated by the same criteria as pharmaceutical drugs, even though treatments such as low-calorie dieting are widely prescribed, require the patients’ time and investment, and may have risks. The Food and Drug Administration (FDA has a procedure for evaluating drugs, in which drugmakers must answer the following questions: (1 Is the treatment safe? (2 How dangerous is the condition the intervention is treating? (3 Is the treatment effective? (4 Is the treatment safe and effective for large numbers of people? We argue that using this framework to evaluate behavioral interventions could help identify unanswered research questions on their efficacy and effectiveness, and we use the example of low-calorie dieting to illustrate how FDA criteria might be applied in the context of behavioral medicine.

A three-temperature model of selective photothermolysis for laser treatment of port wine stain containing large malformed blood vessels

International Nuclear Information System (INIS)

Li, D.; Wang, G.X.; He, Y.L.; Wu, W.J.; Chen, B.

2014-01-01

As congenital vascular malformations, port wine stain (PWS) is composed of ectatic venular capillary blood vessels buried within healthy dermis. In clinic, pulsed dye laser (PDL) in visible band (e.g. 585 nm) together with cryogen spray cooling (CSC) have become the golden standard for treatment of PWS. However, due to the limited energy deposition of the PDL in blood, large blood vessels are likely to survive from the laser irradiation. As a result, complete clearance of the lesions is rarely achieved. Assuming the local thermal non-equilibrium in skin tissue during the laser surgery, a three-temperature model is proposed to treat the PWS tissue as a porous media composed of a non-absorbing dermal matrix buried with the blood as well as the large malformed blood vessels. Three energy equations are constructed and solved coupling for the temperature of the blood in average-sized PWS vessels, non-absorbing dermal tissues and large malformed blood vessels, respectively. Subsequently, the thermal responses of human skin to visible (585 nm) and near-infrared (1064 nm) laser irradiations with various pulse durations in conjunction with cryogen spray cooling are investigated by the new model, and Arrhenius integral is used to analyze the thermal damage. The simulations show that the short pulse duration of 1.5 ms results in a higher selective heating of blood over epidermis, which will lead to a desired clinic outcome than the longer pulse duration. Due to a much deeper light penetration depth, laser irradiation with 1064 nm in wavelength is superior to that with 585 nm in treating patients with cutaneous hyper-vascular malformation. Complete coagulations are predicted in large-sized and deeply extending blood vessels by 1064 nm laser. - Highlights: •A three-temperature model is proposed for the laser treatment of port wine stain (PWS). •Average sized and large malformed blood vessels in porous medium (tissue) are considered. •Thermal responses of PWS to

Traditional Chinese Medicine in the Treatment of Reproductive Disorders of Large Animals in Asia

Directory of Open Access Journals (Sweden)

ZH Zuo, TY Zhang, J Chu, Q Zhang, YX Guo, ZQ Shen and C He

2016-11-01

Full Text Available Reproductive diseases have been a great threat in large animal herds. Before induction of western medicines, traditional Chinese medicine (TCM that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years. The foundational text of Chinese medicine dated back to 5th century to 3rd century BCE, humans in China began developing the TCM therapy by maintaining normal homeostasis and body functions. Traditional Chinese medicine prophylaxis is a very different strategy from that of the western medicine, targeting the balance of the diseased animals as compared to the single lesion. Traditional Chinese medicine was also applied to cure ruminant’s reproductive disorders such as infertility, abortion and retained placenta. With the increasing concerns of the antibiotic resistance and drug abuse happened, TCM has acquired re-recognition as compared to western medicines due to eco-friendly consumer-driven developments and less residue in food chains. More importantly, a growing number of active substances or extracts with the reliable efficacy are being identified, meanwhile, the quality control measures are satisfied in the large-scale production already. However, few TCM is recognized to be used internationally as the popular human medication. Even less TCM is prescribed legally to animal industry due to poor understanding TCM philosophy and lack of the right guidelines of the registration. This summary aims to elucidate the TCM application in the treatment of the reproductive disorder in large animals and offer alternative strategies for prophylaxis.

Effect of the Heat Treatment on the Graphite Matrix of Fuel Element for HTGR

International Nuclear Information System (INIS)

Lee, Chungyong; Lee, Seungjae; Suh, Jungmin; Jo, Youngho; Lee, Youngwoo; Cho, Moonsung

2013-01-01

In this paper, the cylinder-formed fuel element for the block type reactor is focused on, which consists of the large part of graphite matrix. One of the most important properties of the graphite matrix is the mechanical strength for the high reliability because the graphite matrix should be enabled to protect the TRISO particles from the irradiation environment and the impact from the outside. In this study, the three kinds of candidate graphites and Phenol as a binder were chosen and mixed with each other, formed and heated for the compressive strength test. The objective of this research is to optimize the kinds and composition of the mixed graphite and the forming process by evaluating the compressive strength before/after heat treatment (carbonization of binder). In this study, the effect of heat treatment on graphite matrix was studied in terms of the density and the compressive strength. The size (diameter and length) of pellet is increased by heat treatment. Due to additional weight reduction and swelling (length and diameter) of samples the density of graphite pellet is decreased from about 2.0 to about 1.7g/cm 3 . From the mechanical test results, the compressive strength of graphite pellets was related to the various conditions such as the contents of binder, the kinds of graphite and the heat treatment. Both the green pellet and the heat treated pellet, the compressive strength of G+S+P pellets is relatively higher than that of R+S+P pellets. To optimize fuel element matrix, the effect of Phenol and other binders, graphite composition and the heat treatment on the mechanical properties will be deeply investigated for further study

Transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND-study

Directory of Open Access Journals (Sweden)

Geldof Han

2009-03-01

Full Text Available Abstract Background Recent non-randomized studies suggest that extended endoscopic mucosal resection (EMR is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM. If equally effective, EMR might be a more cost-effective approach as this strategy does not require expensive equipment, general anesthesia and hospital admission. Furthermore, EMR appears to be associated with fewer complications. The aim of this study is to compare the cost-effectiveness and cost-utility of TEM and EMR for the resection of large rectal adenomas. Methods/design Multicenter randomized trial among 15 hospitals in the Netherlands. Patients with a rectal adenoma ≥ 3 cm, located between 1–15 cm ab ano, will be randomized to a TEM- or EMR-treatment strategy. For TEM, patients will be treated under general anesthesia, adenomas will be dissected en-bloc by a full-thickness excision, and patients will be admitted to the hospital. For EMR, no or conscious sedation is used, lesions will be resected through the submucosal plane in a piecemeal fashion, and patients will be discharged from the hospital. Residual adenoma that is visible during the first surveillance endoscopy at 3 months will be removed endoscopically in both treatment strategies and is considered as part of the primary treatment. Primary outcome measure is the proportion of patients with recurrence after 3 months. Secondary outcome measures are: 2 number of days not spent in hospital from initial treatment until 2 years afterwards; 3 major and minor morbidity; 4 disease specific and general quality of life; 5 anorectal function; 6 health care utilization and costs. A cost-effectiveness and cost-utility analysis of EMR against TEM for large rectal adenomas will be performed from a societal perspective with respectively the costs per recurrence free patient and the cost per quality adjusted life year as outcome measures. Based on comparable recurrence rates for TEM and EMR

Artificial neural network modelling of a large-scale wastewater treatment plant operation.

Science.gov (United States)

Güçlü, Dünyamin; Dursun, Sükrü

2010-11-01

Artificial Neural Networks (ANNs), a method of artificial intelligence method, provide effective predictive models for complex processes. Three independent ANN models trained with back-propagation algorithm were developed to predict effluent chemical oxygen demand (COD), suspended solids (SS) and aeration tank mixed liquor suspended solids (MLSS) concentrations of the Ankara central wastewater treatment plant. The appropriate architecture of ANN models was determined through several steps of training and testing of the models. ANN models yielded satisfactory predictions. Results of the root mean square error, mean absolute error and mean absolute percentage error were 3.23, 2.41 mg/L and 5.03% for COD; 1.59, 1.21 mg/L and 17.10% for SS; 52.51, 44.91 mg/L and 3.77% for MLSS, respectively, indicating that the developed model could be efficiently used. The results overall also confirm that ANN modelling approach may have a great implementation potential for simulation, precise performance prediction and process control of wastewater treatment plants.

Condutivity effect in electro-coagulation-flotation applied to physico-chemical wastewater treatment

Directory of Open Access Journals (Sweden)

Francisco Javier Cuba Terán

2007-03-01

Full Text Available This study reports on the effect of conductivity on the simultaneous applicability of water electrolysis , chemical coagulation and flotation fundamentals in the treatment of wastewater with large amounts of suspended matter, characterizing electro-coagulation-flotation (ECF . Results from experiments carried out in a pilot study implanted and operated in the Laboratory of Environment Control (LCA, at the State University of Campinas in Limeira are presented. ECF was developed in an electrolytic reactor where water passed through aluminum electrodes connected to a power supply. Electrochemical reactions promoted Al3+ ions emission from anode, neutralizing repulsive pollutant forces, forming flakes. An evolution of micro hydrogen bubbles occurred, carrying the flakes to the top of the solution, causing flotation and polluter removal. System monitoring aimed at reaching optimal operation conditions regarding time of liquid permanence in the reactor, influence of the NaC1 addition on the increase of affluent conductivity, and influence of polarity inversion over cathodic passivation. Results from carwash wastewater treatment reported 86% efficiency rate for color, 90,15% for turbidity and 85,43% for oil and axle-grease removal.

Combined treatment of xenon and hypothermia in newborn rats--additive or synergistic effect?

Directory of Open Access Journals (Sweden)

Hemmen Sabir

Full Text Available Breathing the inert gas Xenon (Xe enhances hypothermic (HT neuroprotection after hypoxia-ischemia (HI in small and large newborn animal models. The underlying mechanism of the enhancement is not yet fully understood, but the combined effect of Xe and HT could either be synergistic (larger than the two effects added or simply additive. A previously published study, using unilateral carotid ligation followed by hypoxia in seven day old (P7 rats, showed that the combination of mild HT (35°C and low Xe concentration (20%, both not being neuroprotective alone, had a synergistic effect and was neuroprotective when both were started with a 4 h delay after a moderate HI insult. To examine whether another laboratory could confirm this finding, we repeated key aspects of the study.After the HI-insult 120 pups were exposed to different post-insult treatments: three temperatures (normothermia (NT NT37°C, HT35°C, HT32°C or Xe concentrations (0%, 20% or 50% starting either immediately or with a 4 h delay. To assess the synergistic potency of Xe-HT, a second set (n = 101 of P7 pups were exposed to either HT35°C+Xe0%, NT+Xe20% or a combination of HT35°C+Xe20% starting with a 4 h delay after the insult. Brain damage was analyzed using relative hemispheric (ligated side/unligated side brain tissue area loss after seven day survival.Immediate HT32°C (p = 0.042, but not HT35°C significantly reduced brain injury compared to NT37°C. As previously shown, adding immediate Xe50% to HT32°C increased protection. Neither 4 h-delayed Xe20%, nor Xe50% at 37°C significantly reduced brain injury (p>0.050. In addition, neither 4 h-delayed HT35°C alone, nor HT35°C+Xe20% reduced brain injury. We found no synergistic effect of the combined treatments in this experimental model.Combining two treatments that individually were ineffective (delayed HT35°C and delayed Xe20% did not exert neuroprotection when combined, and therefore did not show a synergistic

Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness.

Science.gov (United States)

van der Woude, J A D; Nair, S C; Custers, R J H; van Laar, J M; Kuchuck, N O; Lafeber, F P J G; Welsing, P M J

2016-01-01

In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90-95% for the younger age categories. A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient.

Treatment of Large Periapical Cyst Like Lesion: A Noninvasive Approach: A Report of Two Cases.

Science.gov (United States)

Sood, Nikhil; Maheshwari, Neha; Gothi, Rajat; Sood, Niti

2015-01-01

Periapical lesions develop as sequelae to pulp disease. Periapical radiolucent areas are generally diagnosed either during routine dental radiographic examination or following acute toothache. Various methods can be used in the nonsurgical management of periapical lesions: the conservative root canal treatment, decompression technique, active nonsurgical decompression technique, aspiration-irrigation technique, method using calcium hydroxide, lesion sterilization and repair therapy and the apexum procedure. Monitoring the healing of periapical lesions is essential through periodic follow-up examinations. The ultimate goal of endodontic therapy should be to return the involved teeth to a state of health and function without surgical intervention. All inflammatory periapical lesions should be initially treated with conservative nonsurgical procedures. Surgical intervention is recommended only after nonsurgical techniques have failed. Besides, surgery has many drawbacks, which limit its use in the management of periapical lesions. How to cite this article: Sood N, Maheshwari N, Gothi R, Sood N. Treatment of Large Periapical Cyst Like Lesion: A Noninvasive Approach: A Report of Two Cases. Int J Clin Pediatr Dent 2015;8(2):133-137.

Retrospective single center study of the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations in 44 patients with the use of three-dimensional image analysis.

Science.gov (United States)

Kwiek, Bartłomiej; Rożalski, Michał; Kowalewski, Cezary; Ambroziak, Marcin

2017-10-01

We wanted to asses the efficacy of large spot 532 nm laser for the treatment of facial capillary malformations with the use of three-dimensional (3D) image analysis. Retrospective single center study on previously non-treated patients with facial capillary malformations (CM) was performed. A total of 44 consecutive Caucasian patients aged 5-66 were included. Patients had 3D photography performed before and after and had at least one single session of treatment with 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with contact cooling, fluencies ranging from 8 to 11.5 J/cm 2 , pulse duration ranging from 5 to 9 milliseconds and spot size ranging from 5 to 10 mm. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. Median maximal improvement achieved during the treatment (GCE max ) was 70.4%. Mean number of laser procedures required to achieve this improvement was 7.1 (ranging from 2 to 14)). Improvement of minimum 25% (GCE 25) was achieved by all patients, of minimum 50% (GCE 50) by 77.3%, of minimum 75% (GCE 75) by 38.6%, and of minimum 90% (GCE 90) by 13.64. Large spot 532 nm laser is highly effective in the treatment of facial CM. 3D color and area image analysis provides an objective method to compare different methods of facial CM treatment in future studies. Lasers Surg. Med. 49:743-749, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Implant-retained skull prosthesis to cover a large defect of the hairy skull resulting from treatment of a basal cell carcinoma: A clinical report.

Science.gov (United States)

Hoekstra, Jitske; Vissink, Arjan; Raghoebar, Gerry M; Visser, Anita

2017-05-01

Skin carcinoma, particularly basal cell carcinoma, and its treatment can result in large defects of the hairy skull. A 53-year-old man is described who was surgically treated for a large basal cell carcinoma invading the skin and underlying tissue at the top of the hairy skull. Treatment consisted of resecting the tumor and external part of the skull bone. To protect the brain and to cover the defect of the hairy skull, an acrylic resin skull prosthesis with hair was designed to mask the defect. The skull prosthesis was retained on 8 extraoral implants placed at the margins of the defect in the skull bone. The patient was satisfied with the treatment outcome. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Treatment of malignant pleural mesothelioma

International Nuclear Information System (INIS)

Yusa, Toshikazu

2007-01-01

In Japan, it is predicted that mesothelioma will rapidly increase in the future. Malignant pleural mesothelioma that accounts for approximately 90% of mesothelioma as a whole has a median survival time of approximately nine months which is considered a poor prognosis. As for the treatment of this disease, extrapleural pneumonectomy or pleurectomy/decortication are available for those patients who can be surgically operated on. However, since a complete cure rate is low when only surgical treatment is performed, generally a multimodality treatment is performed wherein chemotherapy and/or radiotherapy are combined. For chemotherapy, a large-scale randomized phase III study demonstrated that a treatment using two agents: pemetrexed, which is a new multitargeted antifolate, and cisplatin is effective. Pemetrexed will be the drug of first choice for mesothelioma in the future. As other treatment methods, chemohyperthermia, treatments using various kinds of cytokines and angiogenesis inhibitors, genetic treatment and photodynamic therapy have been attempted. The current treatment results for this disease are very poor, and there has been a strong demand for establishing an effective treatment method. (author)

Electromagnetic and structural coupled analysis with the effect of large deflection

International Nuclear Information System (INIS)

Horie, Tomoyoshi; Niho, Tomoya

1997-01-01

In the designs of future fusion reactors and magnetic levitated vehicles, thin shell conducting structures are located in a high electromagnetic field. The transient magnetic field induces the eddy current on the conductive structure. While the Lorentz force by the eddy current and the magnetic field is loaded to the thin shell structure, the electromotive force by the deflection velocity and magnetic field reduces the eddy current. Therefore, the electromagnetic and structural coupled analysis is required for the design of these components. This paper describes a coupled finite element analysis for the eddy current and the structure. A formulation is presented considering the effect of the large deflection of shell structures by the total Lagrangian formulation. Both matrix equations for the eddy current and the structure are solved simultaneously using coupling sub-matrices. A coupled problem of a cantilever bending plate is analyzed. Based on the analysis results, the influence of the large deflection on the coupling effect is discussed. The condition that the large deflection analysis is required is examined through some parametric analyses

Effectiveness of Acupuncture in the Treatment of Gulf War Illness

Science.gov (United States)

2013-01-01

325. 7 Wigers SH, Stiles TC, Vogael PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia : a 4.5 year prospective study... Treatment of Gulf War Illness PRINCIPAL INVESTIGATOR: Lisa Conboy, M.A., M.S., ScD...December 2012 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Effectiveness of Acupuncture in the Treatment of Gulf War Illness 5b. GRANT NUMBER W81XWH

THERAPEUTIC EFFECTS OF A COGNITIVE-BEHAVIOURAL TREATMENT WITH JUVENILE OFFENDERS

Directory of Open Access Journals (Sweden)

Antonio Andrés-Pueyo

2012-07-01

Full Text Available Several treatment evaluations have highlighted the effectiveness of cognitive-behavioural programmes with both youth and adult offenders. This paper describes the application and assessment of a cognitive-behavioural treatment (adapted to Spanish from Ross and Fabiano’s Reasoning & Rehabilitation Programme with juvenile offenders serving community orders in an educational measure called in Spanish ‘libertad vigilada’ (similar to parole. The intervention comprised six different therapeutic components: self-control, cognitive restructuring, problem solving, social skills/assertiveness, values/empathy, and relapse prevention. Treatment effectiveness was tested using a quasi-experimental design involving two groups and pre/post evaluation. The results show that the programme was effective (with low to moderate effect sizes in improving participants’ social skills and self-esteem, as well as in reducing their aggressiveness. However, the intervention had no positive influence on empathy, cognitive distortions or impulsiveness. These results are in line with those of many other correctional studies, in which the treatment applied had a significant but partial effect on participants.

[Esthetic treatment of varicosities].

Science.gov (United States)

Vin, F

2000-06-01

Telangiectasia is dilatation of the subpapillary venous plexus of the epidermis of the lower limbs, which can lead to aesthetic embarrassment. Before treating telangiectasia, patient history and clinical examination help establishing its origin. It can be with isolated, associated reticular drainage veins, or be part of superficial venous insufficiency. Several types of treatment have been proposed. Microsclerotherapy is the most effective and least costly. Muller's phlebectomy can be performed when telangiectasia is fed by large reticular veins, either afferent or efferent. Treatment by laser and pulsed light appear best reserved to treatment of finer venous dilatations, either complementary or after failure of sclerotherapy.

Treatment effect of methylphenidate on intrinsic functional brain network in medication-naïve ADHD children: A multivariate analysis.

Science.gov (United States)

Yoo, Jae Hyun; Kim, Dohyun; Choi, Jeewook; Jeong, Bumseok

2018-04-01

Methylphenidate is a first-line therapeutic option for treating attention-deficit/hyperactivity disorder (ADHD); however, elicited changes on resting-state functional networks (RSFNs) are not well understood. This study investigated the treatment effect of methylphenidate using a variety of RSFN analyses and explored the collaborative influences of treatment-relevant RSFN changes in children with ADHD. Resting-state functional magnetic resonance imaging was acquired from 20 medication-naïve ADHD children before methylphenidate treatment and twelve weeks later. Changes in large-scale functional connectivity were defined using independent component analysis with dual regression and graph theoretical analysis. The amplitude of low frequency fluctuation (ALFF) was measured to investigate local spontaneous activity alteration. Finally, significant findings were recruited to random forest regression to identify the feature subset that best explains symptom improvement. After twelve weeks of methylphenidate administration, large-scale connectivity was increased between the left fronto-parietal RSFN and the left insula cortex and the right fronto-parietal and the brainstem, while the clustering coefficient (CC) of the global network and nodes, the left fronto-parietal, cerebellum, and occipital pole-visual network, were decreased. ALFF was increased in the bilateral superior parietal cortex and decreased in the right inferior fronto-temporal area. The subset of the local and large-scale RSFN changes, including widespread ALFF changes, the CC of the global network and the cerebellum, could explain the 27.1% variance of the ADHD Rating Scale and 13.72% of the Conner's Parent Rating Scale. Our multivariate approach suggests that the neural mechanism of methylphenidate treatment could be associated with alteration of spontaneous activity in the superior parietal cortex or widespread brain regions as well as functional segregation of the large-scale intrinsic functional

Toxic Stress: Effects, Prevention and Treatment

Directory of Open Access Journals (Sweden)

Hillary A. Franke

2014-11-01

Full Text Available Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.

Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy

DEFF Research Database (Denmark)

Parving, H H; Smidt, U M; Hommel, E

1993-01-01

The effect of long-term, aggressive, antihypertensive treatment on kidney function in diabetic nephropathy was studied prospectively in 11 insulin-dependent diabetic patients (mean age, 30 years). Renal function was assessed every 4 months by measurement of glomerular filtration rate (GFR) (single...... infarction (GFR, 46 mL/min/1.73 m2). Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy....

Prevalence and predictors of Axis I disorders in a large sample of treatment-seeking victims of sexual abuse and incest

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Eoin McElroy

2016-04-01

Full Text Available Background: Childhood sexual abuse (CSA is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective: This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method: The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA (N=434. Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III. Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts and 10 adult clinical syndromes. Results: There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions: The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses.

Seven days of doxycycline is an effective treatment for asymptomatic rectal Chlamydia trachomatis infection.

Science.gov (United States)

Elgalib, A; Alexander, S; Tong, C Y W; White, J A

2011-08-01

There are no evidence-based guidelines for the specific management of rectal Chlamydia trachomatis (CT) infection. All men who have sex with men (MSM) diagnosed with asymptomatic rectal CT by nucleic acid amplification test (NAAT) at a large London genitourinary (GU) medicine clinic between September 2006 and September 2009 were offered oral doxycycline 100 mg twice daily for seven days and invited for a test of cure (TOC) by CT NAAT four weeks after treatment. A total of 487 asymptomatic rectal CT infections were diagnosed and analysis was restricted to 165 TOCs from men whose only treatment had been doxycycline for seven days. The median time post-treatment for TOC was 45 days (interquartile range [IQR], 34-88). Only two patients tested CT-positive at follow-up. One had taken doxycycline only for three days; the other attended for TOC 240 days after the completion of doxycycline treatment and at this time presented with new symptoms in the context of ongoing high sexual risk. Our findings show that doxycycline 100 mg twice daily for seven days is highly effective treatment for asymptomatic rectal CT infection, achieving clearance of CT in 98.8% (163/165; 95% CI 95.4-99.9%) of cases. We advocate doxycycline for seven days as first-line therapy for asymptomatic rectal CT.

Effects of eradication and restoration treatments on Italian thistle (Carduus pycnocephalus)

Science.gov (United States)

McGinnis, Thomas; Keeley, Jon

2011-01-01

Low elevation grasslands in California long have been dominated by Mediterranean grasses, but many areas still have large native forb populations. Alien forbs invade these grasslands, displacing both native and other alien species. Italian thistle is a noxious alien herb that has recently invaded these grasslands, including ungrazed blue oak (Quercus douglassii) and interior live oak (Quercus wislizenii) stands in Sequoia National Park. Here, Italian thistle tends to dominate under oaks and has the potential to substantially alter the foothill ecosystem by displacing native plants and acting as a ladder fuel that can carry fires into the oak canopy. We tested the effects of selectively reducing Italian thistle populations alone and in combination with restoration of native species. Two thistle eradication techniques (clipping and the application of clopyralid herbicide) and two restoration techniques (addition of native forb seeds or planting native grass plugs) were used. After two consecutive years of treatment we found: a) clipping was not effective at reducing Italian thistle populations (clipping reduced Italian thistle density in some areas, but not vegetative cover), b) herbicide reduced both Italian thistle density and vegetative cover for the first two growing seasons after application, but cover rebounded in the third growing season, c) native forb cover and species richness were not significantly affected by clipping or spot-treating with herbicide, d) the grass and forb addition treatments by themselves were not effective at reducing Italian thistle during the course of this study and e) sowing annual forb seeds after clipping resulted in greater forb cover and moderately reduced Italian thistle vegetative cover in the short term.

Cost effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial (UKATT).

Science.gov (United States)

2005-09-10

To compare the cost effectiveness of social behaviour and network therapy, a new treatment for alcohol problems, with that of the proved motivational enhancement therapy. Cost effectiveness analysis alongside a pragmatic randomised trial. Seven treatment sites around Birmingham, Cardiff, and Leeds. 742 clients with alcohol problems; 617 (83.2%) were interviewed at 12 months and full economic data were obtained on 608 (98.5% of 617). Main economic measures Quality adjusted life years (QALYs), costs of trial treatments, and consequences for public sector resources (health care, other alcohol treatment, social services, and criminal justice services). Both therapies saved about five times as much in expenditure on health, social, and criminal justice services as they cost. Neither net savings nor cost effectiveness differed significantly between the therapies, despite the average cost of social behaviour and network therapy (221 pounds sterling; 385 dollars; 320 euros) being significantly more than that of motivational enhancement therapy (129 pounds sterling). If a QALY were worth 30,000 pounds sterling, then the motivational therapy would have 58% chance of being more cost effective than the social therapy, and the social therapy would have 42% chance of being more cost effective than the motivational therapy. Participants reported highly significant reductions in drinking and associated problems and costs. The novel social behaviour and network therapy did not differ significantly in cost effectiveness from the proved motivational enhancement therapy.

The structure-directed effect of Al-based metal–organic frameworks on fabrication of alumina by thermal treatment

International Nuclear Information System (INIS)

Liu, Dandan; Dai, Fangna; Tang, Zhe; Liu, Yunqi; Liu, Chenguang

2015-01-01

Highlights: • We use Al-MOFs as precursor in the fabrication process of mesoporous alumina by thermal treatment. • The obtained mesoporous alumina has dual pore system and five-fold aluminum. • The aluminum building units in the precursor show structure-directed effect on the formation of alumina. - Abstract: In this work, the block-shaped Al-based metal–organic frameworks (Al-MOFs) MIL-53 have been synthesized by hydrothermal method. To detect the correlation between the structure of Al-MOFs and the formation of alumina, the ligands are eliminated by thermal treatment. MIL-53 and the calcination products were characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscope (SEM), transmission electron microscopy (TEM), nitrogen adsorption–desorption and solid-state 27 Al nuclear magnetic resonance ( 27 Al NMR). It was found that after calcination, the block-shaped Al-MOFs precursor turns into high-crystallinity mesoporous alumina nanosheets, and the thermal treatment product γ-alumina possesses a dual pore system and a large surface area (146 m 2 /g), with five-fold aluminum. During the thermal treatment process, the structure of MIL-53 and its secondary building units have structure-directed effect in the formation of alumina

Extremely Large Magnetoresistance at Low Magnetic Field by Coupling the Nonlinear Transport Effect and the Anomalous Hall Effect.

Science.gov (United States)

Luo, Zhaochu; Xiong, Chengyue; Zhang, Xu; Guo, Zhen-Gang; Cai, Jianwang; Zhang, Xiaozhong

2016-04-13

The anomalous Hall effect of a magnetic material is coupled to the nonlinear transport effect of a semiconductor material in a simple structure to achieve a large geometric magnetoresistance (MR) based on a diode-assisted mechanism. An extremely large MR (>10(4) %) at low magnetic fields (1 mT) is observed at room temperature. This MR device shows potential for use as a logic gate for the four basic Boolean logic operations. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Reviewing the literature on access to prompt and effective malaria treatment in Kenya: implications for meeting the Abuja targets

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Tetteh Gladys

2009-10-01

Full Text Available Abstract Background Effective case management is central to reducing malaria mortality and morbidity worldwide, but only a minority of those affected by malaria, have access to prompt effective treatment. In Kenya, the Division of Malaria Control is committed to ensuring that 80 percent of childhood fevers are treated with effective anti-malarial medicines within 24 hours of fever onset, but this target is largely unmet. This review aimed to document evidence on access to effective malaria treatment in Kenya, identify factors that influence access, and make recommendations on how to improve prompt access to effective malaria treatment. Since treatment-seeking patterns for malaria are similar in many settings in sub-Saharan Africa, the findings presented in this review have important lessons for other malaria endemic countries. Methods Internet searches were conducted in PUBMED (MEDLINE and HINARI databases using specific search terms and strategies. Grey literature was obtained by soliciting reports from individual researchers working in the treatment-seeking field, from websites of major organizations involved in malaria control and from international reports. Results The review indicated that malaria treatment-seeking occurs mostly in the informal sector; that most fevers are treated, but treatment is often ineffective. Irrational drug use was identified as a problem in most studies, but determinants of this behaviour were not documented. Availability of non-recommended medicines over-the-counter and the presence of substandard anti-malarials in the market are well documented. Demand side determinants of access include perception of illness causes, severity and timing of treatment, perceptions of treatment efficacy, simplicity of regimens and ability to pay. Supply side determinants include distance to health facilities, availability of medicines, prescribing and dispensing practices and quality of medicines. Policy level factors are around

Cost effective treatment for wet FGD scrubber bleedoff

Energy Technology Data Exchange (ETDEWEB)

Janecek, K.F. [EIMCO Process Equipment Company, Salt Lake City, UT (United States); Kim, J.Y. [Samkook Corporation, Seoul (Korea, Democratic People`s Republic of)

1994-12-31

The dewatering of scrubber bleedoff gypsum is a thoroughly proven technology, whether for production of wallboard grade gypsum or environmentally responsible land fill. Careful review of the technology options will show which one is the most effective for the specific plant site. Likewise, a recipe for wastewater treatment for heavy metals removal can be found that will meet local regulatory limits. EIMCO has worldwide experience in FGD gypsum sludge dewatering and wastewater treatment. Contacting EIMCO can be the most important step toward a practical cost effective system for handling FGD scrubber bleed slurries.

Late effects of treatment of cancer in children

International Nuclear Information System (INIS)

Byrd, R.L.

1983-01-01

Advances in surgical techniques, in chemotherapy, and in radiation therapy have led to improved survival in children treated for cancer. Children cured of cancer will soon form a significant fraction of our adult population. As we follow such survivors, we have become more aware of long-term side effects of treatment. This is not a reason to withhold therapy. Instead, careful followup of oncology patients is needed to document the late effects, to identify the etiologic agents, and to alter treatment to give the least toxic therapy without sacrificing quality or duration of survival

Side effects and risks of radioiodine treatment of benign thyroid diseases

International Nuclear Information System (INIS)

Becker, W.; Hohenberger, W.; Wolf, F.; Erlangen-Nuernberg Univ., Erlangen

1990-01-01

Radioiodine treatment is considered to be the treatment of choice in benign thyroid diseases because of its very low side effects. Real and hypothetic risks and side effects have to be differentiated. Both may occur early and late after the treatment. Radioiodinethyroiditis in small volumes at high doses is very rare. Exacerbation of a thyroid storm (0.34%) as well as local compressions accompanied with reactive edema of the thyroid are early real side effects of radioiodine treatment. Late real side effects are failure of treatment (7-30% of thyrotoxicosis) and induction of hypothyroidism (4-20% of functional autonomy and increasing frequency in Graves' diseases with time). Late hypothetic risks are somatic (1-9/10000 bis 1-9/100000) or genetic (1-9/100000). An early risk might be the misdiagnosis of an additional thyroid carcinoma. (orig.) [de

Effect of Ultrasonic Treatment Combined with Peracetic Acid Treatment Reduces Decay and Maintains Quality in Loquat Fruit

Directory of Open Access Journals (Sweden)

Chen Ling

2018-01-01

Full Text Available The effects of ultrasonic treatment (UT, 400 watts for 6 min combined with peracetic acid (PA, 0.4% (W/W treatment on fruit decay, browning, and quality and physiological changes in loquat fruit stored at 20°C were investigated. The results showed that treatment with UT or PA alone significantly reduced both decay and browning index in loquat fruit compared with the control. The combined treatment was more effective in decreasing decay and browning index and maintaining higher quality parameters than UT or PA treatment alone. Loquat fruits treated with the combined treatment maintained higher activities of polyphenol oxidase (PPO and peroxidase (POD than those treated with other treatments. In addition, UT combined with PA treatment significantly reduced the increase of firmness and increased fruit extractable juice, total soluble solid (TSS, and ascorbic acid content in loquat fruit. Moreover, the contents of total phenolics and total flavonoids were enhanced by the combination of UT and PA treatment. The combination of UT and PA treatment could be a useful method to reduce decay and browning in loquat fruit stored at room temperature, which has potential for application in the loquat industry.

Identifying treatment effect heterogeneity in clinical trials using subpopulations of events: STEPP.

Science.gov (United States)

Lazar, Ann A; Bonetti, Marco; Cole, Bernard F; Yip, Wai-Ki; Gelber, Richard D

2016-04-01

Investigators conducting randomized clinical trials often explore treatment effect heterogeneity to assess whether treatment efficacy varies according to patient characteristics. Identifying heterogeneity is central to making informed personalized healthcare decisions. Treatment effect heterogeneity can be investigated using subpopulation treatment effect pattern plot (STEPP), a non-parametric graphical approach that constructs overlapping patient subpopulations with varying values of a characteristic. Procedures for statistical testing using subpopulation treatment effect pattern plot when the endpoint of interest is survival remain an area of active investigation. A STEPP analysis was used to explore patterns of absolute and relative treatment effects for varying levels of a breast cancer biomarker, Ki-67, in the phase III Breast International Group 1-98 randomized clinical trial, comparing letrozole to tamoxifen as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer. Absolute treatment effects were measured by differences in 4-year cumulative incidence of breast cancer recurrence, while relative effects were measured by the subdistribution hazard ratio in the presence of competing risks using O-E (observed-minus-expected) methodology, an intuitive non-parametric method. While estimation of hazard ratio values based on O-E methodology has been shown, a similar development for the subdistribution hazard ratio has not. Furthermore, we observed that the subpopulation treatment effect pattern plot analysis may not produce results, even with 100 patients within each subpopulation. After further investigation through simulation studies, we observed inflation of the type I error rate of the traditional test statistic and sometimes singular variance-covariance matrix estimates that may lead to results not being produced. This is due to the lack of sufficient number of events within the subpopulations, which we refer to as instability of

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

Energy Technology Data Exchange (ETDEWEB)

Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura [Ospedale Maggiore IRCCS (Pad. Granelli), Institute of Endocrine Sciences, Milan (Italy); Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara [Istituto Clinico Humanitas, Nuclear Medicine Unit, Milan (Italy)

2005-09-01

This study aimed to evaluate the effects of radioiodine ({sup 131}I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive {sup 131}I plus lithium (group I+L) or {sup 131}I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, {sup 131}I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after {sup 131}I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after {sup 131}I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, {sup 131}I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low {sup 131}I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

Radioiodine treatment of non-toxic multinodular goitre: effects of combination with lithium

International Nuclear Information System (INIS)

Vannucchi, Guia; Mannavola, Deborah; Dazzi, Davide; Beck-Peccoz, Paolo; Fugazzola, Laura; Chiti, Arturo; Rodari, Marcello; Tadayyon, Sara

2005-01-01

This study aimed to evaluate the effects of radioiodine ( 131 I), alone or in combination with lithium, on thyroid volume and the prevention of radioiodine-induced thyrotoxicosis. This is the first clinical trial including only patients with multinodular goitre, normal TSH values and negative anti-thyroid auto-antibodies at baseline. Eighty consecutive patients were randomised to receive 131 I plus lithium (group I+L) or 131 I alone (group I). Thyroid ultrasonography and biochemical analyses were performed at baseline and at 1, 3, 6, 12 and 24 months after treatment. At 1-4 weeks after treatment, 131 I-induced hyperthyroidism was observed in 58.8% of patients and was prevented by lithium administration. A low incidence of hypothyroidism (19%) was recorded at 24 months, whereas up to 44% of patients developed anti-thyroid antibodies. A significant reduction in thyroid volume was observed after 131 I, with a mean decrease of 47.2% (median 48.2%) at 24 months, without differences between the groups. Moreover, it was shown that the decrease in thyroid volume after 131 I was also due to the significant shrinkage of thyroid nodules. This demonstrates that adjunctive lithium is able to reduce radioiodine-induced hyperthyroidism. Therefore, such treatment appears to be safe in older patients and those with underlying cardiovascular disease. In the present large series, 131 I therapy was demonstrated to be highly effective in reducing thyroid and nodular volume even in patients treated with low 131 I doses (2.5 MBq/ml of thyroid tissue), further supporting the view that radioiodine therapy represents a real alternative to surgery. (orig.)

Use of principal components analysis (PCA) on estuarine sediment datasets: The effect of data pre-treatment

International Nuclear Information System (INIS)

Reid, M.K.; Spencer, K.L.

2009-01-01

Principal components analysis (PCA) is a multivariate statistical technique capable of discerning patterns in large environmental datasets. Although widely used, there is disparity in the literature with respect to data pre-treatment prior to PCA. This research examines the influence of commonly reported data pre-treatment methods on PCA outputs, and hence data interpretation, using a typical environmental dataset comprising sediment geochemical data from an estuary in SE England. This study demonstrated that applying the routinely used log (x + 1) transformation skewed the data and masked important trends. Removing outlying samples and correcting for the influence of grain size had the most significant effect on PCA outputs and data interpretation. Reducing the influence of grain size using granulometric normalisation meant that other factors affecting metal variability, including mineralogy, anthropogenic sources and distance along the salinity transect could be identified and interpreted more clearly. - Data pre-treatment can have a significant influence on the outcome of PCA.

Advances in surface treatments: Technology, applications, effects

International Nuclear Information System (INIS)

Niku-Lari, A.

1987-01-01

An international handbook has been produced to include all aspects of residual stresses, including the theoretical background, effects of residual stresses, measurement and calculation and quantitative assessment of residual stress effects. Techniques for altering residual stresses, particularly surface treatments, are discussed. Up to date information on the state of the art is presented. (UK)

Comparative efficacy of tulathromycin versus a combination of florfenicol-oxytetracycline in the treatment of undifferentiated respiratory disease in large numbers of sheep

Directory of Open Access Journals (Sweden)

Mohsen Champour

2015-09-01

Full Text Available The objective of this study was to compare the efficacy of tulathromycin (TUL with a combination of florfenicol (FFC and long-acting oxytetracycline (LAOTC in the treatment of naturally occurring undifferentiated respiratory diseases in large numbers of sheep. In this study, seven natural outbreaks of sheep pneumonia in Garmsar, Iran were considered. From these outbreaks, 400 sheep exhibiting the signs of respiratory diseases were selected, and the sheep were randomly divided into two equal groups. The first group was treated with a single injection of TUL (dosed at 2.5 mg/kg body weight, and the second group was treated with concurrent injections of FFC (dosed at 40 mg/kg bwt and LAOTC (dosed at 20 mg/kg bwt. In the first group, 186 (93% sheep were found to be cured 5 days after the injection, and 14 (7% sheep needed further treatment, of which 6 (3% were cured, and 8 (4% died. In the second group, 172 (86% sheep were cured after the injections, but 28 (14% sheep needed further treatment, of which 10 (5% were cured, and 18 (9% died. This study revealed that TUL was more efficacious as compared to the combined treatment using FFC and LAOTC. As the first report, this field trial describes the successful treatment of undifferentiated respiratory diseases in large numbers of sheep. Thus, TUL can be used for the treatment of undifferentiated respiratory diseases in sheep. [J Adv Vet Anim Res 2015; 2(3.000: 279-284

A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning

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Marie Kanstrup

2016-11-01

Full Text Available Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions, including a parent support program (four sessions. Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12 or individual (n = 18 treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01 improvements (medium to large effects in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01 improvements (large effects in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%–63% of the adolescents across the different outcome measures and in 54%–76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.

Effect of sonication treatment on fibrilating snake fruit (Sallaca) frond fiber

Science.gov (United States)

Darmanto, Seno; Rochardjo, Heru S. B.; Jamasri, Widyorini, Ragil

2018-02-01

Aim of this research is to investigate influence of chemical and sonication treatment on fibrillating and mechanical properties of snake fruit frond fiber. The presence of surface impurities and the large amount of hydroxyl groups in natural fibers make less attractive for polymeric materials reinforcement. Effort to remove the impurities can be done by few treatments that consist of physical, chemical and mechanical treatment. Snake fruit frond bundle fiber were firstly subjected to chemical treatments with alkali solution, steaming at 2 bar and steam explosion at 6 bar by 40 times releasing of steam. Advanced treatment is done by flowing ultrasonic wave at 20 kHz by 90 - 210 watt. The output of fibrillation can reach fiber in range 10 - 25 nm compared with 10.72 µm in diameter for sonication and 6 bar in pressure of steam with 40x of rapidly steam release respectively.

Effectiveness and cost-effectiveness of antidepressants in primary care: a multiple treatment comparison meta-analysis and cost-effectiveness model.

Directory of Open Access Journals (Sweden)

Joakim Ramsberg

Full Text Available OBJECTIVE: To determine effectiveness and cost-effectiveness over a one-year time horizon of pharmacological first line treatment in primary care for patients with moderate to severe depression. DESIGN: A multiple treatment comparison meta-analysis was employed to determine the relative efficacy in terms of remission of 10 antidepressants (citalopram, duloxetine escitalopram, fluoxetine, fluvoxamine mirtazapine, paroxetine, reboxetine, sertraline and venlafaxine. The estimated remission rates were then applied in a decision-analytic model in order to estimate costs and quality of life with different treatments at one year. DATA SOURCES: Meta-analyses of remission rates from randomised controlled trials, and cost and quality-of-life data from published sources. RESULTS: The most favourable pharmacological treatment in terms of remission was escitalopram with an 8- to 12-week probability of remission of 0.47. Despite a high acquisition cost, this clinical effectiveness translated into escitalopram being both more effective and having a lower total cost than all other comparators from a societal perspective. From a healthcare perspective, the cost per QALY of escitalopram was €3732 compared with venlafaxine. CONCLUSION: Of the investigated antidepressants, escitalopram has the highest probability of remission and is the most effective and cost-effective pharmacological treatment in a primary care setting, when evaluated over a one year time-horizon. Small differences in remission rates may be important when assessing costs and cost-effectiveness of antidepressants.

Implicit and Explicit Attitudes Toward Spiders : Sensitivity to Treatment and Predictive Value for Generalization of Treatment Effects

NARCIS (Netherlands)

Huijding, Jorg; de Jong, Peter J.

This study tested whether high spider fearful individuals' implicit and explicit attitudes toward spiders are sensitive to exposure treatment, and whether post-treatment implicit and/or explicit attitudes are related to the generalization of treatment effects. Self-reported explicit and implicit

Theoretical evaluations of magnetic nanoparticle-enhanced heating on tumor embedded with large blood vessels during hyperthermia

International Nuclear Information System (INIS)

Wang, Q.; Deng, Z. S.; Liu, J.

2012-01-01

The large blood vessels surrounding the tumor would significantly result in heat sink, and thus seriously limit the thermal ablative area during tumor hyperthermia. Magnetic nanoparticle (MNP) was recently identified as an important heating enhancer to improve the treatment efficiency. It will not only help to absorb more energy under the irradiation of external magnetic field, but also can block the blood flow and subsequently weaken the heat sink effect of large vessels. In this study, these two critical factors, reserved to be undisclosed before in theory, were comprehensively investigated through three-dimensional numerical simulation. The results suggested that concerning the contribution to temperature increase in the tissues surrounding large vessel, the factor of blood flow blocking is more effective than that of energy absorption. Therefore, selective loading of MNPs to the target sites is expected to serve as a promising method to perform successful hyperthermia treatment for tumor tissues embedded with large blood vessels.

Theoretical evaluations of magnetic nanoparticle-enhanced heating on tumor embedded with large blood vessels during hyperthermia

Energy Technology Data Exchange (ETDEWEB)

Wang, Q. [Tsinghua University, Department of Biomedical Engineering, School of Medicine (China); Deng, Z. S. [Chinese Academy of Sciences, Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry (China); Liu, J., E-mail: jliubme@tsinghua.edu.cn [Tsinghua University, Department of Biomedical Engineering, School of Medicine (China)

2012-07-15

The large blood vessels surrounding the tumor would significantly result in heat sink, and thus seriously limit the thermal ablative area during tumor hyperthermia. Magnetic nanoparticle (MNP) was recently identified as an important heating enhancer to improve the treatment efficiency. It will not only help to absorb more energy under the irradiation of external magnetic field, but also can block the blood flow and subsequently weaken the heat sink effect of large vessels. In this study, these two critical factors, reserved to be undisclosed before in theory, were comprehensively investigated through three-dimensional numerical simulation. The results suggested that concerning the contribution to temperature increase in the tissues surrounding large vessel, the factor of blood flow blocking is more effective than that of energy absorption. Therefore, selective loading of MNPs to the target sites is expected to serve as a promising method to perform successful hyperthermia treatment for tumor tissues embedded with large blood vessels.

An investigation of scale effects in family substance abuse treatment programs

Directory of Open Access Journals (Sweden)

Lee A James

2010-07-01

Full Text Available Abstract This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families was too small to be economical. Although the sample size (just nine programs was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.

Deciphering the clinical effect of drugs through large-scale data integration

DEFF Research Database (Denmark)

Kjærulff, Sonny Kim

. This work demonstrates the power of a strategy that uses clinical data mining in association with chemical biology in order to reduce the search space and aid identification of novel drug actions. The second article described in chapter 3 outlines a high confidence side-effect-drug interaction dataset. We...... demonstrates the importance of using high-confidence drug-side-effect data in deciphering the effect of small molecules in humans. In summary, this thesis presents computational systems chemical biology approaches that can help identify clinical effects of small molecules through large-scale data integration...

Large-D gravity and low-D strings.

Science.gov (United States)

Emparan, Roberto; Grumiller, Daniel; Tanabe, Kentaro

2013-06-21

We show that in the limit of a large number of dimensions a wide class of nonextremal neutral black holes has a universal near-horizon limit. The limiting geometry is the two-dimensional black hole of string theory with a two-dimensional target space. Its conformal symmetry explains the properties of massless scalars found recently in the large-D limit. For black branes with string charges, the near-horizon geometry is that of the three-dimensional black strings of Horne and Horowitz. The analogies between the α' expansion in string theory and the large-D expansion in gravity suggest a possible effective string description of the large-D limit of black holes. We comment on applications to several subjects, in particular to the problem of critical collapse.

Dropout among patients in qualified alcohol detoxification treatment: the effect of treatment motivation is moderated by Trauma Load.

Science.gov (United States)

Odenwald, Michael; Semrau, Peter

2013-03-21

Motivation to change has been proposed as a prerequisite for behavioral change, although empirical results are contradictory. Traumatic experiences are frequently found amongst patients in alcohol treatment, but this has not been systematically studied in terms of effects on treatment outcomes. This study aimed to clarify whether individual Trauma Load explains some of the inconsistencies between motivation to change and behavioral change. Over the course of two months in 2009, 55 patients admitted to an alcohol detoxification unit of a psychiatric hospital were enrolled in this study. At treatment entry, we assessed lifetime Trauma Load and motivation to change. Mode of discharge was taken from patient files following therapy. We tested whether Trauma Load moderates the effect of motivation to change on dropout from alcohol detoxification using multivariate methods. 55.4% dropped out of detoxification treatment, while 44.6% completed the treatment. Age, gender and days in treatment did not differ between completers and dropouts. Patients who dropped out reported more traumatic event types on average than completers. Treatment completers had higher scores in the URICA subscale Maintenance. Multivariate methods confirmed the moderator effect of Trauma Load: among participants with high Trauma Load, treatment completion was related to higher Maintenance scores at treatment entry; this was not true among patients with low Trauma Load. We found evidence that the effect of motivation to change on detoxification treatment completion is moderated by Trauma Load: among patients with low Trauma Load, motivation to change is not relevant for treatment completion; among highly burdened patients, however, who a priori have a greater risk of dropping out, a high motivation to change might make the difference. This finding justifies targeted and specific interventions for highly burdened alcohol patients to increase their motivation to change.

Somato-Visceral Effects in the Treatment of Dysmenorrhea: Neuromuscular Manual Therapy and Standard Pharmacological Treatment.

Science.gov (United States)

Barassi, Giovanni; Bellomo, Rosa Grazia; Porreca, Annamaria; Di Felice, Piera Attilia; Prosperi, Loris; Saggini, Raoul

2018-03-01

This study aims to verify whether neuromuscular therapy (NMT) or pharmacology therapy (PT) is more effective for reducing symptoms in women affected by primary dysmenorrhea and the effects associated with each treatment. A controlled, randomized, single-blind clinical trial within the framework of the chair of physical medicine and rehabilitation of the University "G. d'Annunzio" of Chieti-Pescara. The study was conducted on a sample of 60 women suffering from primary dysmenorrhea. Subjects were randomly divided in two groups (A and B). Group A was treated with NMT and group B with PT. Group B was given ibuprofen or naproxen because they are considered the best painkillers for this condition. Group A was treated with 8 neuromuscular manual lumbosacral and abdominal therapy sessions twice per week for 4 weeks. Results were analyzed at the beginning (T0) and end (T1) of the study with a menstrual distress questionnaire, brief pain inventory, and visual analogue scale. Twenty patients from Group A were selected for evaluation of their maintenance of the eventual improvement that was detected in T1 at follow-up (T2). Both therapies had significant short-term effects in reducing the perception and duration of pain. However, NMT appears to give more improvements in the duration of pain. NMT had a long-term effect on perception of pain because patients conserved the positive effects of treatment after 4 weeks. NMT also had a long-term effect on duration of pain because patients conserved benefits of treatment, but this improvement started to decrease after 4 weeks. In the treatment of primary dysmenorrhea, NMT represents a valid therapeutic alternative method to PT. NMT is free from potential adverse effects of analgesics, is noninvasive, and is easy to perform.

Interdisciplinary documentation of treatment side effects in oncology. Present status and perspectives

International Nuclear Information System (INIS)

Seegenschmiedt, M.H.

1998-01-01

Background: The documentation of acute and chronic treatment sequelae is a decisive precondition for the appropriate evaluation of the treatment quality of any cancer therapy. Methods and results: Interdisciplinary (inter)national efforts have resulted in a new consensus for recording of treatment sequelae in oncology. While the acute treatment side effects (day 1 to 90 after treatment) are recommended to be documented and evaluated using the Common Toxicity Criteria (CTC), for the chronic treatment side effects (day 91 and thereafter) the Late Effect Normal Tissue (LENT) criteria are to be implemented. The latter classification system allows to differentiate between the Subjective, Objective, Management and Analytic (SOMA) toxicity aspects. Both classification systems can be implemented not only for clinical applications using radiotherapy or chemotherapy alone but also for combinations with each other or with other treatment modalities. This allows for an effective interdisciplinary comparison between different treatment concepts not only within each institution but also in multicenter trials. Conclusions: Prospective documentation and evaluation of treatment toxicity in oncology should be intensified and systematically included in future mono- and multi-institutional clinical trials. (orig.) [de

ESB application for effective synchronization of large volume measurements data

CERN Document Server

Wyszkowski, Przemysław Michał

2011-01-01

The TOTEM experiment at CERN aims at measurement of total cross section, elastic scattering and diffractive processes of colliding protons in the Large Hadron Collider. In order for the research to be possible, it is necessary to process huge amounts of data coming from variety of sources: TOTEM detectors, CMS detectors, measurement devices around the Large Hadron Collider tunnel and many other external systems. Preparing final results involves also calculating plenty of intermediate figures, which also need to be stored. In order for the work of the scientist to be effective and convenient it is crucial to provide central point for the data storage, where all raw and intermediate figures will be stored. This thesis aims at presenting the usage of Enterprise Service Bus concept in building software infrastructure for transferring large volume of measurements data. Topics discussed here include technologies and mechanisms realizing the concept of integration bus, model of data transferring system based on ...

Frequency of streamflow measurements required to determine forest treatment effects

Science.gov (United States)

Kenneth G. Reinhart

1964-01-01

Most of the stream-discharge records for our experimental watersheds are taken by continuous measurements. But the question arises: are continuous measurements necessary to determine effects of forest treatments? Or could treatment effects be determined by measurement of discharge at intervals, say, once a day or once a week?

Preliminary study of steep pulse irreversible electroporation technology in human large cell lung cancer cell lines L9981

Directory of Open Access Journals (Sweden)

Song Zuoqing

2013-01-01

Full Text Available Our aim was to validate the effectiveness of steep pulse irreversible electroporation technology in human large cell lung cancer cells and to screen the optimal treatment of parameters for human large cell lung cancer cells. Three different sets of steep pulse therapy parameters were applied on the lung cancer cell line L9981. The cell line L9981 inhibition rate and proliferation capacity were detected by Vi-Cell vitality analysis and MTT. Steep pulsed irreversible electroporation technology for large cell lung cancer L9981 presents killing effects with various therapy parameters. The optimal treatment parameters are at a voltage amplitude of 2000V/cm, pulse width of 100μs, pulse frequency of 1 Hz, pulse number 10. With this group of parameters, steep pulse could have the best tumor cell-killing effects.

Effect of patient's life expectancy on the cost-effectiveness of treatment for ocular hypertension.

Science.gov (United States)

Kymes, Steven M; Plotzke, Michael R; Kass, Michael A; Boland, Michael V; Gordon, Mae O

2010-05-01

To assess the influence of expected life span on the cost-effectiveness of treating ocular hypertension to prevent primary open-angle glaucoma. We used a Markov simulation model to estimate the cost and benefit of ocular hypertension treatment over a person's remaining life. We examined the influence of age on the cost-effectiveness decision in 2 ways: (1) by evaluating specific age cohorts to assess the influence of age at the initiation of treatment; and (2) by evaluating the influence of a specific life span. At a willingness to pay $50,000/quality-adjusted life year to $100,000/quality-adjusted life year, treatment of people with a 2% or greater annual risk of developing glaucoma was cost-effective for people aged 45 years with a life expectancy of at least 18 remaining years. However, to be cost-effective, a person aged 55 years must have a life expectancy of 21 remaining years and someone aged 65 years must have a life expectancy of 23 remaining years. A person with ocular hypertension must have a life expectancy of at least 18 remaining years to justify treatment at a threshold of a 2% or greater annual risk of developing glaucoma. Persons at higher levels of risk require a life expectancy of 7 to 10 additional years to justify treatment.

Factors Associated with Effectiveness of Treatment and Reproductive Outcomes in Patients with Thin Endometrium Undergoing Estrogen Treatment

Directory of Open Access Journals (Sweden)

Si-Miao Liu

2015-01-01

Conclusions: Thinner EMT before estrogen treatment requires longer treatment duration and predicts poorer treatment outcomes. The effectiveness of treatment depends on the duration of estrogen administration. Assisted reproductive outcomes of patients whose treatment is successful (i.e., achieves an EMT ≥8 mm are similar to those of controls. The quality of embryos transferred is an important predictor of assisted reproductive outcomes in patients treated successfully with exogenous estrogen.

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation.

Science.gov (United States)

Thurgar, Elizabeth; Barton, Samantha; Karner, Charlotta; Edwards, Steven J

2016-03-01

Typically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited. To systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments. Electronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies. A systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources. Of 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of

Effect of pre-cooling and heat treatment on antioxidant enzymes ...

African Journals Online (AJOL)

Effect of pre-cooling and heat treatment on antioxidant enzymes profile of mango and banana. ... In banana, pre-cooling treatment (8 ºC) and heat treatment followed by cooling reduced CAT activity in peel and pulp, whereas POX activity increased. Pre-cooling and heat treatments altered normal homeostasis of these fruits, ...

Neutron flux shape effects in large fast reactor safety calculations

International Nuclear Information System (INIS)

Galati, A.; Loizzo, P.; Musco, A.

1978-01-01

Three classes of accidents in a large fast reactor were studied by the two-dimensional core dynamics code NADYP-2. A Modified version of the code, including a point kinetics module, allowed comparison between 2D and 0D power, reactivity and temperature histories. A strong shape effect was evidenced by these calculations in the boiling phase of LOF accidents as well as in the accident generated by control rod removal. Some future possibilities of by passing the consequences of this effect are indicated

Network meta-analysis of disconnected networks: How dangerous are random baseline treatment effects?

Science.gov (United States)

Béliveau, Audrey; Goring, Sarah; Platt, Robert W; Gustafson, Paul

2017-12-01

In network meta-analysis, the use of fixed baseline treatment effects (a priori independent) in a contrast-based approach is regularly preferred to the use of random baseline treatment effects (a priori dependent). That is because, often, there is not a need to model baseline treatment effects, which carry the risk of model misspecification. However, in disconnected networks, fixed baseline treatment effects do not work (unless extra assumptions are made), as there is not enough information in the data to update the prior distribution on the contrasts between disconnected treatments. In this paper, we investigate to what extent the use of random baseline treatment effects is dangerous in disconnected networks. We take 2 publicly available datasets of connected networks and disconnect them in multiple ways. We then compare the results of treatment comparisons obtained from a Bayesian contrast-based analysis of each disconnected network using random normally distributed and exchangeable baseline treatment effects to those obtained from a Bayesian contrast-based analysis of their initial connected network using fixed baseline treatment effects. For the 2 datasets considered, we found that the use of random baseline treatment effects in disconnected networks was appropriate. Because those datasets were not cherry-picked, there should be other disconnected networks that would benefit from being analyzed using random baseline treatment effects. However, there is also a risk for the normality and exchangeability assumption to be inappropriate in other datasets even though we have not observed this situation in our case study. We provide code, so other datasets can be investigated. Copyright © 2017 John Wiley & Sons, Ltd.

Direct Computation of Sound Radiation by Jet Flow Using Large-scale Equations

Science.gov (United States)

Mankbadi, R. R.; Shih, S. H.; Hixon, D. R.; Povinelli, L. A.

1995-01-01

Jet noise is directly predicted using large-scale equations. The computational domain is extended in order to directly capture the radiated field. As in conventional large-eddy-simulations, the effect of the unresolved scales on the resolved ones is accounted for. Special attention is given to boundary treatment to avoid spurious modes that can render the computed fluctuations totally unacceptable. Results are presented for a supersonic jet at Mach number 2.1.

Long-term treatment of phenylketonuria with a new medical food containing large neutral amino acids.

Science.gov (United States)

Concolino, D; Mascaro, I; Moricca, M T; Bonapace, G; Matalon, K; Trapasso, J; Radhakrishnan, G; Ferrara, C; Matalon, R; Strisciuglio, P

2017-01-01

Phenylketonuria (PKU) is an autosomal recessive disease caused by deficient activity of phenylalanine hydroxylase. A low phenylalanine (Phe) diet is used to treat PKU. The diet is very restrictive, and dietary adherence tends to decrease as patients get older. Methods to improve dietary adherence and blood Phe control are continuously under investigation. A new formula Phe-neutral amino acid (PheLNAA) has been tested in this study with the purpose of improving the compliance and lowering blood phenylalanine. The formula has been tested for nitrogen balance, and it is nutritionally complete. It is fortified with more nutritional additives that can be deficient in the PKU diet, such as B12, Biotin, DHA, Lutein and increased levels of large neutral amino acids to help lower blood Phe. The new formula has been tested on 12 patients with a loading test of 4 weeks. Fifty-eight percent of patients had a significant decline in blood Phe concentration from baseline throughout the study. The PheLNAA was well tolerated with excellent compliance and without illnesses during the study. In conclusion, the new formula is suitable for life-long treatment of PKU, and it offers the PKU clinic a new choice for treatment.

Surface-Treated versus Untreated Large-Bore Catheters as Vascular Access in Hemodialysis and Apheresis Treatments

Directory of Open Access Journals (Sweden)

Rolf Bambauer

2012-01-01

Full Text Available Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992–2007 evaluated silver-coated (54 patients and noncoated (105 patients implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface.

Weightbath hydrotraction treatment: application, biomechanics, and clinical effects

Directory of Open Access Journals (Sweden)

Márta Kurutz

2010-04-01

Full Text Available Márta Kurutz1, Tamás Bender21Department of Structural Mechanics, Budapest University of Technology and Economics, Hungary; 2Department of Physical Medicine, Polyclinic and Hospital of the Hospitaller Brothers of St. John of God, Budapest, Medical University of Szeged, HungaryBackground and purpose: Weightbath hydrotraction treatment (WHT is a simple noninvasive effective method of hydro- or balneotherapy to stretch the spine or lower limbs, applied successfully in hospitals and health resort sanitaria in Hungary for more than fifty years. This study aims to introduce WHT with its biomechanical and clinical effects. History, development, equipment, modes of application, biomechanics, spinal traction forces and elongations, indications and contraindications of WHT are precented.Subjects and methods: The calculation of traction forces acting along the spinal column during the treatment is described together with the mode of suspension and the position of extra weight loads applied. The biomechanics of the treatment are completed by in vivo measured elongations of lumbar segments using a special underwater ultrasound measuring method. The clinical effects, indications, and contraindications of the treatment are also presented.Results: In the underwater cervical suspension of a human body, approximately 25 N stretching load occurs in the cervical spine, and about 11 N occurs in the lumbar spine. By applying extra weights, the above tensile forces along the spinal column can be increased. Thus, the traction effect can be controlled by applying such loads during the treatment. Elongations of segments L3–L4, L4–L5, and L5–S1 were measured during the usual WHT of patients suspended cervically in water for 20 minutes, loaded by 20–20 N lead weights on the ankles. The mean initial elastic elongations of spinal segments were about 0.8 mm for patients aged under 40 years, 0.5 mm between 40–60 years, and 0.2 mm for patients over 60 years. The mean

Revisiting the Effectiveness of Large Optical Telescopes

Directory of Open Access Journals (Sweden)

V. V. Sychev

2015-01-01

back action of design elements and propagation medium on the transmitted radiation wave-front;- lack of a basic source of radiation on the laser radiation wavelength, which is necessary for the adaptive correction methods to be applied to distorted wave-front;- inherent only in laser systems additional distorting factors available in transmitting systems.Such distorting factors are as follows:• length of optical path because of spacing necessary for a high-power laser source with a large number of the consistent optical elements;• thermal self-influence of powerful laser radiation in the channel of radiation transportation before its input in the forming optical system;• instability of spatiotemporal characteristics of laser radiation source itself, which worsens passing radiation conditions both in an optical path and in the free atmosphere;• thermal heterogeneity and thermal deformations.It is shown that adaptive systems are distinguished from active optics by the fact that correction of the radiation wave-front distortions occurs in real time on the entire set of the distorting factors (not only on influence of the atmosphere with the speed much exceeding action of distortions. Thus, the quality correction is assessed according to criterion of quality of primary image.Thus, correction continuously considers information on the current spatial, temperature, temporary, and justified parameters of the optical system, providing quality maintenance of the image under conditions of distorting factors.The main postulates of adaptive correction are formulated and offered.Postulates represent the set of statements and provisions allowing us to realize effective remedies of adaptive correction of distortions.It is also shown what real opportunities are open by using methods and means of adaptive optics in effective application of laser radiation power and what ways allow us to solve these tasks. First of all, it is:- forming a system of assumptions and minimizing the

Large Neutral Amino Acid Supplementation Exerts Its Effect through Three Synergistic Mechanisms: Proof of Principle in Phenylketonuria Mice.

Directory of Open Access Journals (Sweden)

Danique van Vliet

Full Text Available Phenylketonuria (PKU was the first disorder in which severe neurocognitive dysfunction could be prevented by dietary treatment. However, despite this effect, neuropsychological outcome in PKU still remains suboptimal and the phenylalanine-restricted diet is very demanding. To improve neuropsychological outcome and relieve the dietary restrictions for PKU patients, supplementation of large neutral amino acids (LNAA is suggested as alternative treatment strategy that might correct all brain biochemical disturbances caused by high blood phenylalanine, and thereby improve neurocognitive functioning.As a proof-of-principle, this study aimed to investigate all hypothesized biochemical treatment objectives of LNAA supplementation (normalizing brain phenylalanine, non-phenylalanine LNAA, and monoaminergic neurotransmitter concentrations in PKU mice.C57Bl/6 Pah-enu2 (PKU mice and wild-type mice received a LNAA supplemented diet, an isonitrogenic/isocaloric high-protein control diet, or normal chow. After six weeks of dietary treatment, blood and brain amino acid and monoaminergic neurotransmitter concentrations were assessed.In PKU mice, the investigated LNAA supplementation regimen significantly reduced blood and brain phenylalanine concentrations by 33% and 26%, respectively, compared to normal chow (p<0.01, while alleviating brain deficiencies of some but not all supplemented LNAA. Moreover, LNAA supplementation in PKU mice significantly increased brain serotonin and norepinephrine concentrations from 35% to 71% and from 57% to 86% of wild-type concentrations (p<0.01, respectively, but not brain dopamine concentrations (p = 0.307.This study shows that LNAA supplementation without dietary phenylalanine restriction in PKU mice improves brain biochemistry through all three hypothesized biochemical mechanisms. Thereby, these data provide proof-of-concept for LNAA supplementation as a valuable alternative dietary treatment strategy in PKU. Based on these

Cost-effectiveness of lanreotide Autogel in treatment algorithms of acromegaly

NARCIS (Netherlands)

Biermasz, Nienke R.; Roelfsema, Ferdinand; Pereira, Alberto M.; Romijn, Johannes A.

2009-01-01

The introduction of effective pharmacological treatments has changed the management of acromegaly. However, chronic, life-long treatment with somatostatin analogues and/or growth hormone receptor antagonists is very expensive. We estimated the costs of treatment algorithms to control acromegaly from

Effect of Female Body Mass Index on Oocyte Quantity in Fertility Treatments (IVF: Treatment Cycle Number Is a Possible Effect Modifier. A Register-Based Cohort Study.

Directory of Open Access Journals (Sweden)

Mette Wulf Christensen

Full Text Available Overweight and obese women may require higher doses of gonadotrophin when undergoing In Vitro Fertilization Treatment (IVF. Consequently, one may expect a sub-optimal oocyte retrieval in the first treatment cycle and thus a larger compensation in gonadotrophin-dose in the following treatment-cycles and a more favorable outcome. The main objective was to explore if treatment cycle number modifies the outcome when investigating the effect of female Body Mass Index (BMI on oocyte quantity in IVF.A historical cohort study was conducted on 5,342 treatment-cycles during the period 1999-2009. Exclusion criteria were missing information on BMI or treatment type. Further, women were excluded if they had ovulated before oocyte retrieval. According to baseline BMI, women were divided into four categories following the World Health Organization standards. Multiple linear regressions analyses were performed accounting for the non-independence of ≥2 cycles in a woman.Stratification according to cycle number revealed a more suboptimal outcome in the first treatment- cycles than in the following cycles, suggesting a possible interaction or effect modification from cycle number or a factor related to cycle number. The median dose of total follicular stimulating hormone given to the four BMI groups could not straight forwardly explain the less optimal oocyte outcome observed in first treatment cycles. No statistically significant differences were observed in oocyte yield for underweight, overweight and obesity compared to normal weight women when analyzing all treatment-cycles. Overweight women had significantly fewer mature (MII oocytes (p = 0.009 than normal weight women, whereas no differences was observed for underweight and obese women.Our study suggests a possible interaction or effect modification related to treatment cycle number. Investigating the effects of BMI on IVF-results in first treatment-cycles alone should be carried out cautiously.

The effects and consequences of very large explosive volcanic eruptions.

Science.gov (United States)

Self, S

2006-08-15

Every now and again Earth experiences tremendous explosive volcanic eruptions, considerably bigger than the largest witnessed in historic times. Those yielding more than 450km3 of magma have been called super-eruptions. The record of such eruptions is incomplete; the most recent known example occurred 26000 years ago. It is more likely that the Earth will next experience a super-eruption than an impact from a large meteorite greater than 1km in diameter. Depending on where the volcano is located, the effects will be felt globally or at least by a whole hemisphere. Large areas will be devastated by pyroclastic flow deposits, and the more widely dispersed ash falls will be laid down over continent-sized areas. The most widespread effects will be derived from volcanic gases, sulphur gases being particularly important. This gas is converted into sulphuric acid aerosols in the stratosphere and layers of aerosol can cover the global atmosphere within a few weeks to months. These remain for several years and affect atmospheric circulation causing surface temperature to fall in many regions. Effects include temporary reductions in light levels and severe and unseasonable weather (including cool summers and colder-than-normal winters). Some aspects of the understanding and prediction of super-eruptions are problematic because they are well outside modern experience. Our global society is now very different to that affected by past, modest-sized volcanic activity and is highly vulnerable to catastrophic damage of infrastructure by natural disasters. Major disruption of services that society depends upon can be expected for periods of months to, perhaps, years after the next very large explosive eruption and the cost to global financial markets will be high and sustained.

[Comparative effectiveness of different treatment methods of liver failure].

Science.gov (United States)

Kutepov, D E; Vershinina, M G; Pasechnik, I N; Sal'nikov, P S

2014-01-01

It was analyzed the results of treatment of 217 patients (139 men, 78 women) with chronic liver failure in case of liver cirrhosis of various etiology for study of degree of hepatic encephalopathyregression. All patients were divided into 3 groups. In the first group the drug therapy was used. In the second group additionallyplasma exchange was performed, in the third group - alsomolecular absorbent recirculating system was used (effectiveness of MARS-therapy).The results showed that the use of extracorporeal treatment techniques can effectively reduce the severity of hepatic encephalopathy in patients with liver cirrhosis. MARS-therapy improved the neurological status of patientsmore significantly in this case. It is considered that the inclusion of MARS-therapy in the combined treatment of patients leads to a significant reduction of hepatic encephalopathyseverity (1-2 points), in comparison with other methods of treatment.

Cancer treatment: fertility and sexual side effects in women

Science.gov (United States)

... Cancer treatment: fertility and sexual side effects in women To use the sharing features on this page, ... Bladder cancer Types of Sexual Side Effects For women, the most common sexual side effects include: Loss ...

Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients: a population-based analysis.

Science.gov (United States)

Khor, Sara; Beca, Jaclyn; Krahn, Murray; Hodgson, David; Lee, Linda; Crump, Michael; Bremner, Karen E; Luo, Jin; Mamdani, Muhammad; Bell, Chaim M; Sawka, Carol; Gavura, Scott; Sullivan, Terrence; Trudeau, Maureen; Peacock, Stuart; Hoch, Jeffrey S

2014-08-12

Current treatment of diffuse-large-B-cell lymphoma (DLBCL) includes rituximab, an expensive drug, combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. Economic models have predicted rituximab plus CHOP (RCHOP) to be a cost-effective alternative to CHOP alone as first-line treatment of DLBCL, but it remains unclear what its real-world costs and cost-effectiveness are in routine clinical practice. We performed a population-based retrospective cohort study from 1997 to 2007, using linked administrative databases in Ontario, Canada, to evaluate the costs and cost-effectiveness of RCHOP compared to CHOP alone. A historical control cohort (n = 1,099) with DLBCL who received CHOP before rituximab approval was hard-matched on age and treatment intensity and then propensity-score matched on sex, comorbidity, and histology to 1,099 RCHOP patients. All costs and outcomes were adjusted for censoring using the inverse probability weighting method. The main outcome measure was incremental cost per life-year gained (LYG). Rituximab was associated with a life expectancy increase of 3.2 months over 5 years at an additional cost of $16,298, corresponding to an incremental cost-effectiveness ratio of $61,984 (95% CI $34,087-$135,890) per LYG. The probability of being cost-effective was 90% if the willingness-to-pay threshold was $100,000/LYG. The cost-effectiveness ratio was most favourable for patients less than 60 years old ($31,800/LYG) but increased to $80,600/LYG for patients 60-79 years old and $110,100/LYG for patients ≥ 80 years old. We found that post-market survival benefits of rituximab are similar to or lower than those reported in clinical trials, while the costs, incremental costs and cost-effectiveness ratios are higher than in published economic models and differ by age. Our results showed that the addition of rituximab to standard CHOP chemotherapy was associated with improvement in survival but at a higher cost, and was

SU-E-T-235: Data Mining for Evaluating Treatment Performances Over a Large Quantity of Data to Monitor and Improve SBRT Workflow

Energy Technology Data Exchange (ETDEWEB)

Feng, W [Columbia University Medical Center, New York, NY (United States); Bayhealth Medical Center, Dover, DE (United States); Chu, A [New York Presbyterian Hospital, New York, AA (United States); Wuu, C [Columbia University, New York, NY (United States); Nguyen, K [Bayhealth Medical Center, Dover, DE (United States)

2015-06-15

Purpose: To quality assure a large quantity of retrospective treatment cases for treatment performances by randomly sampling is inefficient. Here we provide a method to efficiently monitor and investigate the QA of SBRT workflow over Mosaiq. Methods: The code developed with Microsoft SQL Server Management Studio 2008R2 and VBA was used for retrieving and sorting data from Mosaiq (version 2.3–2.6 during 2012–2015). SBRT patients were filtered by fractional dose over 350cGy and total fraction number less than 6, which SBRT prescriptions were defined. The quality assurance on the SBRT workflow was focused on the treatment deliveries such as patient positioning setup, CBCT indicated offsets and couch shifted corrections. The treatment delivery were done by Varian Truebeam systems and the record/verify by Mosaiq. Results: Total 82 SBRT patients corresponding to 103 courses and 854 CBCT images were found by the retrieval query. Most centers record daily pre-treatment (Pre-Tx: before treatment shift) image-guided shifts along treatment course for inter-fraction motion record, and it is useful to also verify it with post-treatment imaging (Post-Tx: after treatment CBCT verification) to verify intra-fraction motion. Analyzing the details of daily recorded shifts can reveals the information of patient-setup and staff’s record/verify behaviors. 3 examples were provided as solid evidences and on-going rectification for preventing future mistakes. Conclusions: The report gave feasible examples for inspector to verify a large amount of data during site investigation. This program can also be extended to a scheduled data mining with software to periodical analyze the timely records in Mosaiq, for example, a various control charts for different QA purposes. As the current trend of automation in radiation therapy field, the data mining would be a necessary tool in the future, just as the automatic plan quality evaluation has been under development in Eclipse.

SU-E-T-235: Data Mining for Evaluating Treatment Performances Over a Large Quantity of Data to Monitor and Improve SBRT Workflow

International Nuclear Information System (INIS)

Feng, W; Chu, A; Wuu, C; Nguyen, K

2015-01-01

Purpose: To quality assure a large quantity of retrospective treatment cases for treatment performances by randomly sampling is inefficient. Here we provide a method to efficiently monitor and investigate the QA of SBRT workflow over Mosaiq. Methods: The code developed with Microsoft SQL Server Management Studio 2008R2 and VBA was used for retrieving and sorting data from Mosaiq (version 2.3–2.6 during 2012–2015). SBRT patients were filtered by fractional dose over 350cGy and total fraction number less than 6, which SBRT prescriptions were defined. The quality assurance on the SBRT workflow was focused on the treatment deliveries such as patient positioning setup, CBCT indicated offsets and couch shifted corrections. The treatment delivery were done by Varian Truebeam systems and the record/verify by Mosaiq. Results: Total 82 SBRT patients corresponding to 103 courses and 854 CBCT images were found by the retrieval query. Most centers record daily pre-treatment (Pre-Tx: before treatment shift) image-guided shifts along treatment course for inter-fraction motion record, and it is useful to also verify it with post-treatment imaging (Post-Tx: after treatment CBCT verification) to verify intra-fraction motion. Analyzing the details of daily recorded shifts can reveals the information of patient-setup and staff’s record/verify behaviors. 3 examples were provided as solid evidences and on-going rectification for preventing future mistakes. Conclusions: The report gave feasible examples for inspector to verify a large amount of data during site investigation. This program can also be extended to a scheduled data mining with software to periodical analyze the timely records in Mosaiq, for example, a various control charts for different QA purposes. As the current trend of automation in radiation therapy field, the data mining would be a necessary tool in the future, just as the automatic plan quality evaluation has been under development in Eclipse

Endovascular strategy for the elective treatment of concomitant aortoiliac aneurysm and symptomatic large bowel diverticular disease.

Science.gov (United States)

Illuminati, Giulio; Ricco, Jean-Baptiste; Schneider, Fabrice; Caliò, Francesco G; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

2014-07-01

The purpose of this study was to evaluate the strategy for treatment of patients presenting with asymptomatic diverticular disease of the large bowel associated with an asymptomatic aortoiliac aneurysmal (AAA) disease. Sixty-nine patients were included in this retrospective study. The patients were divided into 5 groups according to the type and sequence of the surgical treatment: 32 patients (47%) underwent colectomy followed by a staged open AAA repair (group A); 10 patients (14%) were treated with open AAA repair followed by a staged colectomy (group B); 13 patients (18%) received endovascular aneurysm repair (EVAR) followed by a staged bowel resection (group C); 8 patients (12%) had a bowel resection followed by staged EVAR (group D); and 6 patients (9%) underwent simultaneous open AAA repair and bowel resection (group E). Primary end points were mortality and complications after any of the procedures. Secondary end point was the time interval between the staged procedures. The cumulative death rate for delayed treatment of AAA was 6.5% and 0% for delayed treatment of diverticular disease [P=0.22]. The mean time interval between the staged procedures was 11 days for EVAR/colon resection (group C and group D) and 73 days for open AAA repair/colon resection (group A and group B; P<0.01). EVAR allows a significant reduction in the time required between AAA repair and colon resection, but no definite rule can be established regarding the sequence of staged procedures. Combined procedures should be reserved for selected cases. Copyright © 2014 Elsevier Inc. All rights reserved.

Effect of pre-treatments on seed germination of Parkia biglobosa ...

African Journals Online (AJOL)

Effect of pre-treatments on seed germination of Parkia biglobosa (Benth) ... There has been emphasis on the use of indigenous tree species to check land ... out to investigate the most effective pre-sowing treatments to break seed dormancy and to ... Matured seeds of P. biglobosa were collected from farmers at Mbalagh ...

Dosimetric characterization of hypofractionated Gamma Knife radiosurgery of large or complex brain tumors versus linear accelerator-based treatments.

Science.gov (United States)

Dong, Peng; Pérez-Andújar, Angélica; Pinnaduwage, Dilini; Braunstein, Steve; Theodosopoulos, Philip; McDermott, Michael; Sneed, Penny; Ma, Lijun

2016-12-01

OBJECTIVE Noninvasive Gamma Knife (GK) platforms, such as the relocatable frame and on-board imaging, have enabled hypofractionated GK radiosurgery of large or complex brain lesions. This study aimed to characterize the dosimetric quality of such treatments against linear accelerator-based delivery systems that include the CyberKnife (CK) and volumetric modulated arc therapy (VMAT). METHODS Ten patients treated with VMAT at the authors' institution for large brain tumors (> 3 cm in maximum diameter) were selected for the study. The median prescription dose was 25 Gy (range 20-30 Gy) in 5 fractions. The median planning target volume (PTV) was 9.57 cm 3 (range 1.94-24.81 cm 3 ). Treatment planning was performed using Eclipse External Beam Planning V11 for VMAT on the Varian TrueBeam system, Multiplan V4.5 for the CyberKnife VSI System, and Leksell GammaPlan V10.2 for the Gamma Knife Perfexion system. The percentage of the PTV receiving at least the prescription dose was normalized to be identical across all platforms for individual cases. The prescription isodose value for the PTV, conformity index, Paddick gradient index, mean and maximum doses for organs at risk, and normal brain dose at variable isodose volumes ranging from the 5-Gy isodose volume (V5) to the 15-Gy isodose volume (V15) were compared for all of the cases. RESULTS The mean Paddick gradient index was 2.6 ± 0.2, 3.2 ± 0.5, and 4.3 ± 1.0 for GK, CK, and VMAT, respectively (p 0.06). The average prescription isodose values were 52% (range 47%-69%), 60% (range 46%-68%), and 88% (range 70%-94%) for GK, CK, and VMAT, respectively, thus producing significant variations in dose hot spots among the 3 platforms. Furthermore, the mean V5 values for GK and CK were similar (p > 0.79) at 71.9 ± 36.2 cm 3 and 73.3 ± 31.8 cm 3 , respectively, both of which were statistically lower (p linear accelerator-based treatments. Such a result supports the use of a large number of isocenters or confocal beams for the

Maximizing cost-effectiveness by adjusting treatment strategy according to glaucoma severity

Science.gov (United States)

Guedes, Ricardo Augusto Paletta; Guedes, Vanessa Maria Paletta; Gomes, Carlos Eduardo de Mello; Chaoubah, Alfredo

2016-01-01

Abstract Background: The aim of this study is to determine the most cost-effective strategy for the treatment of primary open-angle glaucoma (POAG) in Brazil, from the payer's perspective (Brazilian Public Health System) in the setting of the Glaucoma Referral Centers. Methods: Study design was a cost-effectiveness analysis of different treatment strategies for POAG. We developed 3 Markov models (one for each glaucoma stage: early, moderate and advanced), using a hypothetical cohort of POAG patients, from the perspective of the Brazilian Public Health System (SUS) and a horizon of the average life expectancy of the Brazilian population. Different strategies were tested according to disease severity. For early glaucoma, we compared observation, laser and medications. For moderate glaucoma, medications, laser and surgery. For advanced glaucoma, medications and surgery. Main outcome measures were ICER (incremental cost-effectiveness ratio), medical direct costs and QALY (quality-adjusted life year). Results: In early glaucoma, both laser and medical treatment were cost-effective (ICERs of initial laser and initial medical treatment over observation only, were R$ 2,811.39/QALY and R$ 3,450.47/QALY). Compared to observation strategy, the two alternatives have provided significant gains in quality of life. In moderate glaucoma population, medical treatment presented the highest costs among treatment strategies. Both laser and surgery were highly cost-effective in this group. For advanced glaucoma, both tested strategies were cost-effective. Starting age had a great impact on results in all studied groups. Initiating glaucoma therapy using laser or surgery were more cost-effective, the younger the patient. Conclusion: All tested treatment strategies for glaucoma provided real gains in quality of life and were cost-effective. However, according to the disease severity, not all strategies provided the same cost-effectiveness profile. Based on our findings, there should be a

Effective Treatment of Manganese-Induced Occupational Parkinsonism With p-Aminosalicylic Acid: A Case of 17-Year Follow-Up Study

Science.gov (United States)

Jiang, Yue-Ming; Mo, Xue-An; Du, Feng-Qi; Fu, Xue; Zhu, Xia-Yan; Gao, Hong-Yu; Xie, Jin-Lan; Liao, Feng-Ling; Pira, Enrico; Zheng, Wei

2014-01-01

Objective Chronic manganese (Mn) intoxication induces syndromes resembling Parkinson disease. The clinical intervention has largely been unsuccessful. We report a 17-year follow-up study of effective treatment of occupational Mn parkinsonism with sodium para-aminosalicylic acid (PAS). Methods The patient, female and aged 50 at the time of treatment, was exposed to airborne Mn for 21 years (1963–1984). The patient had palpitations, hand tremor, lower limb myalgia, hypermyotonia, and a distinct festinating gait. She received 6 g PAS per day through an intravenous drip infusion for 4 days and rested for 3 days as one therapeutic course. Fifteen such courses were carried out between March and June 1987. Results At the end of PAS treatment, her symptoms were significantly alleviated, and handwriting recovered to normal. Recent follow-up examination at age 67 years (in 2004) showed a general normal presentation in clinical, neurologic, brain magnetic resonance imaging, and handwriting examinations with a minor yet passable gait. Conclusions This case study suggests that PAS appears to be an effective drug for treatment of severe chronic Mn poisoning with a promising prognosis. PMID:16766929

A hard-to-read font reduces the framing effect in a large sample.

Science.gov (United States)

Korn, Christoph W; Ries, Juliane; Schalk, Lennart; Oganian, Yulia; Saalbach, Henrik

2018-04-01

How can apparent decision biases, such as the framing effect, be reduced? Intriguing findings within recent years indicate that foreign language settings reduce framing effects, which has been explained in terms of deeper cognitive processing. Because hard-to-read fonts have been argued to trigger deeper cognitive processing, so-called cognitive disfluency, we tested whether hard-to-read fonts reduce framing effects. We found no reliable evidence for an effect of hard-to-read fonts on four framing scenarios in a laboratory (final N = 158) and an online study (N = 271). However, in a preregistered online study with a rather large sample (N = 732), a hard-to-read font reduced the framing effect in the classic "Asian disease" scenario (in a one-sided test). This suggests that hard-read-fonts can modulate decision biases-albeit with rather small effect sizes. Overall, our findings stress the importance of large samples for the reliability and replicability of modulations of decision biases.

Large-order behavior of nondecoupling effects in the standard model and triviality

International Nuclear Information System (INIS)

Aoki, K.

1994-01-01

We compute some nondecoupling effects in the standard model, such as the ρ parameter, to all orders in the coupling constant expansion. We analyze their large order behavior and explicitly show how they are related to the nonperturbative cutoff dependence of these nondecoupling effects due to the triviality of the theory

The effects of surface treatments on rapid chloride permeability tests

KAUST Repository

Yoon, Seyoon

2012-08-01

Surface treatments are commonly applied to improve the chloride resistance of concrete structures exposed to saline environments. Information on chloride ingress to surface-treated concrete is mostly provided by application of the rapid chloride permeability test (RCPT); this test is short in duration and provides rapid results. This study presents a numerical formulation, based on the extended Nernst-Plank/Poisson (NPP) equation, to model the effect of the surface treatment on a sample tested by RCPT. Predictions of the model are compared to experimental measurements. The simulations show that the results from RCPT, in terms of ionic profiles and measurement of the electric field, are dependent on the effectiveness of surface treatments. During RCPT, highly effective surface treatments cause both cations and anions to flocculate at the interface between the surface treatment and the concrete, creating a local electric field. Our numerical model includes these phenomena and presents a methodology to obtain more accurate diffusivities of the surface-treated- concrete from RCPT. © 2012 Elsevier B.V. All rights reserved.

The effects of surface treatments on rapid chloride permeability tests

KAUST Repository

Yoon, Seyoon; Oh, Sang-gyun; Ha, Juyoung; Monteiro, Paulo M.

2012-01-01

Surface treatments are commonly applied to improve the chloride resistance of concrete structures exposed to saline environments. Information on chloride ingress to surface-treated concrete is mostly provided by application of the rapid chloride permeability test (RCPT); this test is short in duration and provides rapid results. This study presents a numerical formulation, based on the extended Nernst-Plank/Poisson (NPP) equation, to model the effect of the surface treatment on a sample tested by RCPT. Predictions of the model are compared to experimental measurements. The simulations show that the results from RCPT, in terms of ionic profiles and measurement of the electric field, are dependent on the effectiveness of surface treatments. During RCPT, highly effective surface treatments cause both cations and anions to flocculate at the interface between the surface treatment and the concrete, creating a local electric field. Our numerical model includes these phenomena and presents a methodology to obtain more accurate diffusivities of the surface-treated- concrete from RCPT. © 2012 Elsevier B.V. All rights reserved.

Quantum tunneling observed without its characteristic large kinetic isotope effects.

Science.gov (United States)

Hama, Tetsuya; Ueta, Hirokazu; Kouchi, Akira; Watanabe, Naoki

2015-06-16

Classical transition-state theory is fundamental to describing chemical kinetics; however, quantum tunneling is also important in explaining the unexpectedly large reaction efficiencies observed in many chemical systems. Tunneling is often indicated by anomalously large kinetic isotope effects (KIEs), because a particle's ability to tunnel decreases significantly with its increasing mass. Here we experimentally demonstrate that cold hydrogen (H) and deuterium (D) atoms can add to solid benzene by tunneling; however, the observed H/D KIE was very small (1-1.5) despite the large intrinsic H/D KIE of tunneling (≳ 100). This strong reduction is due to the chemical kinetics being controlled not by tunneling but by the surface diffusion of the H/D atoms, a process not greatly affected by the isotope type. Because tunneling need not be accompanied by a large KIE in surface and interfacial chemical systems, it might be overlooked in other systems such as aerosols or enzymes. Our results suggest that surface tunneling reactions on interstellar dust may contribute to the deuteration of interstellar aromatic and aliphatic hydrocarbons, which could represent a major source of the deuterium enrichment observed in carbonaceous meteorites and interplanetary dust particles. These findings could improve our understanding of interstellar physicochemical processes, including those during the formation of the solar system.

Effects of surface treatments on microstructure in stainless steel

International Nuclear Information System (INIS)

Mabuchi, Yasuhiro; Tamako, Hiroaki; Kaneda, Junya; Yamashita, Norimichi; Miyakawa, Masahiko

2009-01-01

It is revealed that Stress Corrosion Cracking (SCC) on the surface of the L-grade stainless steels in Nuclear Power Plants is caused by heavily cold work of the materials. The microstructure, hardness and residual stress on the surface of the material are factors for SCC initiation. There are surface treatment methods that is effective reduction on SCC such as Flap Wheel (FW) polishing, Clean N Strip (CNS) polishing, Water Jet Peening (WJP) and Shot Peening (SP). In this paper, the characteristics of the surface cold worked layer of the L-grade stainless steels conducted by above-mentioned surface treatments are analyzed, and effects of the surface treatments on the surface layer are discussed. (author)

Chemistry of cost effective water treatment programme in HWP (Manuguru)

International Nuclear Information System (INIS)

Mohapatra, C.; Laxmana Prasad, K.

2008-01-01

In order to develop a water treatment programme following points must be kept in mind: Effectiveness to achieve desired water quality objectives; Compliance with regulatory requirements; Cost minimization; Safety; Easy operation and protection to equipments. Heavy Water Plant (Manuguru) laboratory has developed treatment programs to treat raw water and cooling water which satisfy the above requirements and has been in use for last several years successfully without any problem. These treatment programs have been given to other plants in Heavy Water Board for implementation. This paper describes the chemistry of the treatment program and cost minimization achieved. Further these treatments have helped the plant in achieving ΦZero Discharge and indirectly reduced the production cost. The chemistry parameters are monitored regularly to ascertain the effectiveness of these treatments. The areas where significant benefits derived are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and development of in-house cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments helped the plant in achieving Zero discharge and indirectly reduced production cost of heavy water. The dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15 - 20 Lakhs in a year besides other advantages. The changeover of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs. 1.4 Crore a year along with other advantages. The change over of proprietary formulation to in-house formulation in cooling water treatment has resulted a saving about Rs. 11 Lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored (author)

Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators.

Science.gov (United States)

Jansen, Jeroen P; Incerti, Devin; Mutebi, Alex; Peneva, Desi; MacEwan, Joanna P; Stolshek, Bradley; Kaur, Primal; Gharaibeh, Mahdi; Strand, Vibeke

2017-07-01

To determine the cost-effectiveness of treatment sequences of biologic disease-modifying anti-rheumatic drugs or Janus kinase/STAT pathway inhibitors (collectively referred to as bDMARDs) vs conventional DMARDs (cDMARDs) from the US societal perspective for treatment of patients with moderately to severely active rheumatoid arthritis (RA) with inadequate responses to cDMARDs. An individual patient simulation model was developed that assesses the impact of treatments on disease based on clinical trial data and real-world evidence. Treatment strategies included sequences starting with etanercept, adalimumab, certolizumab, or abatacept. Each of these treatment strategies was compared with cDMARDs. Incremental cost, incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each treatment sequence relative to cDMARDs. The cost-effectiveness of each strategy was determined using a US willingness-to-pay (WTP) threshold of $150,000/QALY. For the base-case scenario, bDMARD treatment sequences were associated with greater treatment benefit (i.e. more QALYs), lower lost productivity costs, and greater treatment-related costs than cDMARDs. The expected ICERs for bDMARD sequences ranged from ∼$126,000 to $140,000 per QALY gained, which is below the US-specific WTP. Alternative scenarios examining the effects of homogeneous patients, dose increases, increased costs of hospitalization for severely physically impaired patients, and a lower baseline Health Assessment Questionnaire (HAQ) Disability Index score resulted in similar ICERs. bDMARD treatment sequences are cost-effective from a US societal perspective.

Effects of topical application of Curcuma longa extract in the treatment of early periodontal diseases

Directory of Open Access Journals (Sweden)

Vikrant Sharma

2016-01-01

Full Text Available Background: Treatment of plaque-induced periodontal disease is largely based on the mechanical debridement of the tooth surface and meticulous maintenance of oral hygiene thereafter. Various chemical plaque control agents are used as adjuncts along with the mechanical plaque control methods for this treatment. Most of these chemical plaque control agents have varied side effects. This has led to the search of natural products which are highly effective in controlling plaque microbes while being biocompatible. Turmeric is one such well-known plant product, known for its varied medicinal value. Aim: The aim of this study is to evaluate the clinical efficacy of Curcuma longa oral formulation in treatment of infective inflammatory early periodontal diseases. Materials and Methods: This clinical study comprised twenty individuals presenting with clinical features of plaque-induced gingivitis and mild periodontitis. Three groups were randomly made in mouth of each patient selected for the study. Group I was treated with scaling and root planing (SCRP only. Group II was treated with SCRP plus C. longa oral formulation topical application for 2 weeks. Group III was treated only with topical application of C. longa extract oral formulation for 2 weeks. Gingival index, sulcus bleeding index, and plaque index were scored in each group before and after the treatment. Results: The results showed statistically significant improvement with respect to all the clinical parameters in all the three groups. However, Group II showed the maximum improvement (P < 0.001, followed by Group I (P < 0.001 and Group III (P < 0.05. The intergroup difference between the three groups for the improvements in clinical parameters was statistically nonsignificant. Conclusion: The oral formulation containing C. longa extract is effective in treating early infective-inflammatory periodontal diseases not only when used as an adjunct to SCRP but also when used alone.

A Method for Measuring Treatment Effects on the Treated without Randomization

Directory of Open Access Journals (Sweden)

P.A.V.B. Swamy

2016-03-01

Full Text Available This paper contributes to the literature on the estimation of causal effects by providing an analytical formula for individual specific treatment effects and an empirical methodology that allows us to estimate these effects. We derive the formula from a general model with minimal restrictions, unknown functional form and true unobserved variables such that it is a credible model of the underlying real world relationship. Subsequently, we manipulate the model in order to put it in an estimable form. In contrast to other empirical methodologies, which derive average treatment effects, we derive an analytical formula that provides estimates of the treatment effects on each treated individual. We also provide an empirical example that illustrates our methodology.

Home Hemodialysis (HHD Treatment as an Effective yet Underutilized Treatment Modality in the United States

Directory of Open Access Journals (Sweden)

Jihane J. Hajj

2017-11-01

Full Text Available End-stage renal disease (ESRD is a major health burden and its incidence has been increasing yearly reaching 120,000 cases in 2014. Home hemodialysis (HHD is a treatment modality option that has been shown to contribute to numerous clinical benefits but is largely underutilized due to many contributing factors. The purpose of this review paper is to analyze the advantages and disadvantages of HHD and the reasons for its low utilization with a special focus on its socioeconomic impact as compared to facility hemodialysis. Key factors contributing to HHD underutilization are related to the reimbursement system of the facility and nephrologists as well as the underutilization of the pre-dialysis educational benefit. Based on this comprehensive review of the literature, we propose several suggestions which may contribute to the expansion of HHD treatment modality.

On the Renormalization of the Effective Field Theory of Large Scale Structures

OpenAIRE

Pajer, Enrico; Zaldarriaga, Matias

2013-01-01

Standard perturbation theory (SPT) for large-scale matter inhomogeneities is unsatisfactory for at least three reasons: there is no clear expansion parameter since the density contrast is not small on all scales; it does not fully account for deviations at large scales from a perfect pressureless fluid induced by short-scale non-linearities; for generic initial conditions, loop corrections are UV-divergent, making predictions cutoff dependent and hence unphysical. The Effective Field Theory o...

Predicting the effect of psychoeducational group treatment for hypochondriasis.

NARCIS (Netherlands)

Buwalda, F.M.; Bouman, T.K.

2008-01-01

Both individual cognitive-behavioural therapy and short-term psychoeducational courses have shown to be effective in reducing hypochondriacal complaints. However, it is unknown which patients benefit from treatment. The aim of the present study is to explore which variables predict treatment outcome

Effects of thermal treatments and germination on physico-chemical ...

African Journals Online (AJOL)

Certain physico-chemical properties including viscoelasticity, crystallinity and maltose content of corn depends on the gelatinization of starch under different treatments. Three different treatments were performed; boiling in water, steam heating, and germination. The effects of gelatinization on viscoelastic property of corn ...

Effect of intermittent treatment with amodiaquine on anaemia and malarial fevers in infants in Tanzania: a randomised placebo-controlled trial

DEFF Research Database (Denmark)

Massaga, Julius J; Kitua, Andrew Y; Lemnge, Martha M

2003-01-01

: Presumptive intermittent treatment for malaria with amodiaquine reduced malarial fevers and anaemia in infants, in an area with high resistance to other antimalarials. Intermittent treatment strategies for malaria in highly endemic areas could be of great benefit to public health.......BACKGROUND: Malaria is a major cause of infant morbidity and mortality in sub-Saharan Africa, and is often complicated by severe anaemia. Resistance of Plasmodium falciparum to most affordable antimalarial drugs is an impediment to intermittent chemotherapy. We investigated the effect...... of presumptive intermittent treatment with amodiaquine and daily iron supplementation in infants on malarial fevers and anaemia, in a holoendemic area of Tanzania where malaria is largely resistant to chloroquine and sulfadoxine/ pyrimethamine. METHODS: 291 infants aged 12-16 weeks who attended three clinics...

The effects of physicochemical wastewater treatment operations on forward osmosis

OpenAIRE

Hey, Tobias; Bajraktari, Niada; Vogel, Jörg; Hélix-Nielsen, Claus; La Cour Jansen, Jes; Jönsson, Karin

2016-01-01

Raw municipal wastewater from a full-scale wastewater treatment plant was physicochemically pretreated in a large pilot-scale system comprising coagulation, flocculation, microsieve and microfiltration operated in various configurations. The produced microsieve filtrates and microfiltration permeates were then concentrated using forward osmosis (FO). Aquaporin Inside(TM) FO membranes were used for both the microsieve filtrate and microfiltration permeates, and Hydration Technologies Inc.-thin...

The effect of the novel internal-type linear inductive antenna for large area magnetized inductive plasma source

Science.gov (United States)

Lee, S. H.; Shulika, Olga.; Kim, K. N.; Yeom, G. Y.; Lee, J. K.

2004-09-01

As the technology of plasma processing progresses, there is a continuing demand for higher plasma density, uniformity over large areas and greater control over plasma parameters to optimize the processes of etching, deposition and surface treatment. Traditionally, the external planar ICP sources with low pressure high density plasma have limited scale-up capabilities due to its high impedance accompanied by the large antenna size. Also due to the cost and thickness of their dielectric material in order to generate uniform plasma. In this study the novel internal-type linear inductive antenna system (1,020mm¡¿830mm¡¿437mm) with permanent magnet arrays are investigated to improve both the plasma density and the uniformity of LAPS (Large Area Plasma Source) for FPD processing. Generally plasma discharges are enhanced because the inductance of the novel antenna (termed as the double comb antenna) is lower than that of the serpentine-type antenna and also the magnetic confinement of electron increases the power absorption efficiency. The uniformity is improved by reducing the standing wave effect. The total length of antenna is comparable to the driving rf wavelength to cause the plasma nonuniformity. To describe the discharge phenomenon we have developed a magnetized two-dimensional fluid simulation. This work was supported by National Research Laboratory (NRL) Program of the Korea Ministry of Science and Technology. [References] 1. J.K.Lee, Lin Meng, Y.K.Shin, H,J,Lee and T.H.Chung, ¡°Modeling and Simulation of a Large-Area Plasma Source¡±, Jpn. J. Appl. Phys. Vol.36(1997) pp. 5714-5723 2. S.E.Park, B.U.Cho, Y.J.Lee*, and G.Y.Yeom*, and J.K.Lee, ¡°The Characteristics of Large Area Processing Plasmas¡±, IEEE Trans. Plasma Sci., Vol.31 ,No.4(2003) pp. 628-637

On the importance of prompt oxygen changes for hypofractionated radiation treatments

International Nuclear Information System (INIS)

Kissick, Michael; Campos, David; Van der Kogel, Albert; Kimple, Randall

2013-01-01

This discussion is motivated by observations of prompt oxygen changes occurring prior to a significant number of cancer cells dying (permanently stopping their metabolic activity) from therapeutic agents like large doses of ionizing radiation. Such changes must be from changes in the vasculature that supplies the tissue or from the metabolic changes in the tissue itself. An adapted linear–quadratic treatment is used to estimate the cell survival variation magnitudes from repair and reoxygenation from a two-fraction treatment in which the second fraction would happen prior to significant cell death from the first fraction, in the large fraction limit. It is clear the effects of oxygen changes are likely to be the most significant factor for hypofractionation because of large radiation doses. It is a larger effect than repair. Optimal dose timing should be determined by the peak oxygen timing. A call is made to prioritize near real time measurements of oxygen dynamics in tumors undergoing hypofractionated treatments in order to make these treatments adaptable and patient-specific. (note)

Effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia – a multi-centre randomised controlled trial